摘要
目的探讨肺结核并发肺部真菌感染的危险因素，为临床防治提供参考依据。方法选取2011年7月至2016年6月肺结核并发肺部真菌感染患者98例，按照1：1配比病例对照研究，使用自行设计的调查问卷进行调查，研究因素包括15个变量。先采用单因素分析，对进入多因素模型的14个变量采用多因素条件Logistic回归分析。结果单因素分析结果显示，年龄构成、体质指数（BMI）、营养状况、病程长短、肺结核初复治、痰菌、临床症状、肺部病灶范围、影像学特点、应用广谱抗菌药物、应用糖皮质激素、合并肺部其他疾病、合并糖尿病、侵入性操作等14个因素均与并发肺部真菌感染存在显著相关，差异有统计学意义（P〈0．05或P〈0．01）。多因素分析结果显示，年龄≥60岁、肺结核复治、痰菌阴性、病程≥5年、肺部病灶范围≥3个肺野、纤维化及空洞型病变、广谱抗菌药物应用≥2周、糖皮质激素应用≥2周、合并肺部其他疾病、合并糖尿病、侵入性操作等11项影响因素是肺结核并发肺部真菌感染的危险因素，OR值分别为2．084、2．457、3．015、2．583、3．019、4．356、3．224、4．593、2．859、3．226、2．355。结论肺结核并发肺部真菌感染的原因是多方面的，对老年复治痰菌阴性肺结核、病程长且病灶范围广泛、长期应用广谱抗菌药物、长期应用糖皮质激素以及合并糖尿病的患者，应特别警惕并发肺部真菌感染。
Objective To explore the risk factors of pulmonary tuberculosis （ TB ） complicated with pulmonary fungal infection, so as to provide evidence for clinical prevention and treatment. Methods Totally 98 cases of pulmonary tuberculosis complicated with pulmonary fungal infection were selected in our hospital from Jul. 2011 to Jun. 2016, a 1 ： 1 matched case-control study was used. All of people were investigated by unified self-designed questionnaire, which including 15 research factors. First, the single factor chi-square test was used, there were 14 factors into the multiple condition logistic regression model. Then the multivariate conditional logistic regression model were used for analysis, calculate OR values, P values less than 0.05 were considered as statistically significant. Results Univariate analysis results showed that 14 factors were statistically related （ P〈0.05 or P〈0.01 ） to pulmonary fungal infection. They were age structure, BMI, nutrition, duration Of disease, initial and retreat pulmonary TB, sputum tubercle bacilli, clinical symptom, pulmonary lesion range, imagine features, application of broad-spectrum antibiotics and glucocorticoid, complicated with other lung diseases, complicated with diabetes, invasive procedures. Multivariable conditional logistic regression analysis showed that over 60 years old, retreat pulmonary TB, sputum smear negative, duration of disease more than 5 years, lesion over 3 pulmonary fields, fibrosis and cavity imagine, application of broad-spectrum antibiotics and glucocorticoid for more two weeks, complicated with other lung diseases, complicated with diabetes and invasive procedures were all susceptible to pulmonary fungal infection. The OR values were 2.084, 2.457, 3.015, 2.583, 3.019, 4.356, 3.224, 4.593, 2.859, 3.226 and 2.355. Conclusions The causes of pulmonary TB complicated with pulmonary fungal infection are varied. These people who are sputum smear negative retreat pulmonary TB in the elderly, long disease duration and wide range of pulmonary lesion, long term application of broad-spectrum antibiotics or glucocorticoid and complicated with diabetes should be especially vigilant to be complicated with pulmonary fungal infection.
出处
《浙江临床医学》
2017年第7期1228-1230,共3页
Zhejiang Clinical Medical Journal
关键词
肺结核
肺部真菌感染
危险因素
病例对照研究
Pulmonary tuberculosis Pulmonary fungal infection Risk factors Case-control study
