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目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者肺部真菌感染的病原学特点及危险因素。方法选择2010年1月—2013年6月住院发生肺部真菌感染的COPD患者150例作为观察组,从同期住院的COPD患者中随机抽取未发生肺部真菌感染患者150例作为对照组。对两组的病历资料进行分析,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果白色念珠菌58.0%、光滑念珠菌8.7%、热带念珠菌8.0%、近平滑念珠菌4.0%、克柔念珠菌4.7%、曲霉菌16.0%、隐球菌0.7%。治疗后临床症状缓解、真菌转阴124例,自动出院16例,死亡9例,肺部曲菌球转胸外科手术治疗1例。年龄>65岁、广谱抗生素应用>3周、类固醇激素应用、体内留置导管、机械通气、慢性基础病、住院时间>20 d是肺部真菌感染的危险因素。结论预防COPD患者肺部真菌感染的主要措施是积极治疗原发病及合并症,合理应用抗生素及激素,加强对症支持治疗,增强免疫力。
Objective To investigate the etiological characteristics and risk factors of pulmonary fungal infection in patients with chronic obstructive pulmonary diseases (COPD). Methods A total of 150 COPD patients with pulmonary fungal infection hospitalized from January 2010 to June 2013 were selected as the observation group and 150 patients without pulmonary fungal infection were randomly selected from COPD patients hospitalized in the same period as control group. Analysis of the two groups of medical records, count data using χ2 test, P <0.05 for the difference was statistically significant. Results Candida albicans 58.0%, Candida glabrata 8.7%, Candida tropicalis 8.0%, Candida parapsilosis 4.0%, Candida krusei 4.7%, Aspergillus 16.0%, Cryptococcus neoformans 0.7%. The clinical symptoms were relieved after treatment, with 124 cases of fungal negative conversion, 16 cases of spontaneous discharge, 9 cases of death and 1 case of lung aspergillosis treated by thoracic surgery. Age> 65 years old, broad-spectrum antibiotics for> 3 weeks, steroid use, indwelling catheter, mechanical ventilation, chronic basic disease, hospital stay> 20 d were risk factors for pulmonary fungal infection. Conclusion The main measures to prevent pulmonary fungal infection in patients with COPD are aggressive treatment of primary disease and complications, rational use of antibiotics and hormones, enhancement of symptomatic and supportive treatment, and enhancement of immunity.