摘要
目的分析老年2型糖尿病患者隐匿性肺部感染现状及其危险因素。方法选取2017年1月-2019年12月杭州师范大学附属医院收治的2型糖尿病合并社区获得性肺部感染老年患者286例,根据肺部感染的隐匿性分为隐匿性肺炎组134例和非隐匿性肺炎组152例,回顾性分析患者临床病历资料,总结老年糖尿病患者合并隐匿性肺炎的感染特点,采用单因素及多因素Logistic回归分析其危险因素。结果 134例隐匿性肺炎组患者病原菌培养阳性110例,阳性率为82.09%,共检出病原菌157株;152例非隐匿性肺炎组病原菌培养阳性者有135例,阳性率为88.82%,共检出病原菌183株;两组患者病原菌培养阳性率比较差异无统计学意义(χ^(2)=2.264,P>0.05);阳性患者检出病原菌分布比较差异无统计学意义(χ^(2)=2.473,P>0.05);两组治疗情况大致相似,隐匿组肺炎组患者住院时间和病死率均高于非隐匿性肺炎组(P<0.05);两组年龄、合并老年痴呆、甲状腺功能减退、实验室指标[白细胞计数(WBC)、降钙素原(PCT)、血清白蛋白(ALB)水平]及长时间卧床情况比较,差异有统计学意义(P<0.05);多因素Logistic回归发现,高龄(OR=1.984)、合并症[甲状腺功能减退(OR=1.511)、老年痴呆(OR=1.470)]及长时间卧床(OR=1.267)是老年糖尿病患者出现隐匿性肺炎的独立危险因素(P<0.05)。结论老年糖尿病患者合并肺部感染常具有隐匿性,病原菌以革兰阴性菌为主,预后情况较差,其中高龄、合并症(老年痴呆、甲状腺功能减退)及长时间卧床是患者出现隐匿性肺炎的独立危险因素。
OBJECTIVE To investigate the current status and risk factors for occult pulmonary infection in the elderly patients with diabetes mellitus(T2 DM).METHODS A total of 286 elderly T2 DM patients complicated with community-acquired pulmonary infection who were treated in Affiliated Hospital of Hangzhou Normal University from Jan 2017 to Dec 2019 were enrolled in the study and divided into the occult pneumonia group with 134 cases and the non-occult pneumonia group with 152 cases according to the status of occult pulmonary infection.The clinical data of the patients were retrospectively analyzed,the features of the elderly T2 DM patients complicated with occult pneumonia were summarized,and univariate analysis and multivariate logistic regression analysis were performed for the risk factors.RESULTS Totally 110 of 134 patients were positive for culture of pathogens in the occult pneumonia group,with the positive rate 82.09%,and totally 157 strains of pathogens were isolated.Totally 135 of 152 patients were positive for culture of pathogens in the non-occult pneumonia group,with the positive rate 88.82%,and totally 183 strains of pathogens were isolated;there was no significant difference in the positive rate of culture of pathogens between the two groups of patients(χ^(2)=2.264,P>0.05);there was no significant difference in the distribution of the isolated pathogens among the positive patients(χ^(2)=2.473,P>0.05).The treatment outcomes of the two groups were basically same,and the length of hospital stay and mortality rate of the occult pneumonia group were significantly higher than those of the non-occult pneumonia group(P<0.05).There were significant differences in the age,complication with senile dementia,hypothyroidism,laboratory test indexes[white blood cell(WBC),procalcitonin(PCT),albumin(ALB)levels]and long bedridden time between the two groups(P<0.05).Multivariate logistic regression analysis showed that the advanced age(OR=1.984),complications[hypothyroidism(OR=1.511),senile dementia(OR=1.470)]and long bedridden time(OR=1.267)were the independent risk factors for the occult pneumonia in the elderly patients with diabetes mellitus(P<0.05).CONCLUSION The pulmonary infection is often occult in the elderly patients with diabetes mellitus.The gram-negative bacteria are dominant among the pathogens.Their prognosis is poor.The advanced age,complications(senile dementia,hypothyroidism)and long bedridden time are the independent risk factors for the occult pneumonia.
作者
杨燕丽
张秋玲
杨璐
瞿欢佳
朱莉菲
YANG Yan-li;ZHANG Qiu-ling;YANG Lu;QU Huan-jia;ZHU Li-fei(Affiliated Hospital of Hangzhou Normal University,Hangzhou Zhejiang 310010,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第1期1-5,共5页
Chinese Journal of Nosocomiology
基金
浙江省省科研基金资助项目(2018321141)。
