慢性阻塞性肺疾病急性加重期患者痰培养真菌检出率及相关因素分析

摘要

Objective To provide a basis for judging the accuracy of fungi positive in sputum culture and for the diagnosis of pulmonary fungal disease in clinical work calculating the detection rate of fungi in sputum culture in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and analyzing the relevant factors.Methods 978 patients with AECOPD admitted to the Department of Respiratory Medicine of our hospital from October,2014 to October,2017 were selected as the research objects.The detection of fungi in sputum culture,distribution of pathogenic bacteria,and related influencing factors were observed and analyzed.Results Among the 978 AECOPD patients,253 were found to have fungi in the sputum culture,with a detection rate of 25.86％;and 119 patients were diagnosed with pulmonary mycosis,accounting for 12.17％.Univariate analysis showed that long-term use of antibiotics and glucocorticoids,mechanical ventilation,and hypoproteinemia were associated with AECOPD combined with pulmonary fungal infection (all P ＜ 0.05).Conclusion The incidence of pulmonary mycosis in patients with AECOPD is lower than that in patients with fungi in sputum culture.The occurrence of pulmonary mycosis relates to the treatment methods and the patients' state.Clinicians should make a preliminary judgment on the fungi in sputum culture,take reasonable treatment measures,and actively improve the patients' nutritional status in order to reduce the incidence of pulmonary mycosis and to better treat the patients.%目的 统计慢性阻塞性肺疾病急性加重期(AECOPD)患者痰培养真菌检出率,并分析其相关因素,为临床工作中判断痰培养真菌阳性对肺真菌病诊断的准确率提供依据.方法 选取本院呼吸内科2014年10月至2017年10月收治的978例AECOPD患者作为研究对象,对AECOPD患者痰培养真菌检出情况、病原菌分布及相关影响因素进行观察和分析.结果 978例AECOPD患者中,253例痰培养中检出真菌,检出率为25.86％;诊断为肺部真菌病的患者有119例,占所有AECOPD患者的12.17％.单因素结果分析显示长期应用抗生素、糖皮质激素,机械通气及低蛋白血症与AECOPD合并肺部真菌感染有关(均P＜0.05).结论 AECOPD患者肺部真菌病患病率低于痰培养真菌检出率,其发生与治疗方式及自身状态均有相关性,临床医生应对痰培养真菌进行初步判断,采取合理的治疗措施,积极改善患者营养状态,以减少肺部真菌病的发生,更好地治疗患者.