CAJ | 학술논문

目的：探讨慢性阻塞性肺疾病(COPD)患者并发真菌性肺炎的危险因素。方法选择2012年1月~2013年12月住院期间并发真菌性肺炎的COPD患者65例为感染组，以同期无真菌性肺炎的COPD住院患者2014例作为对照组，分析COPD并发真菌性肺炎与广谱抗生素种类和疗程、是否联用甲强龙、血清白蛋白水平及APACHEⅡ评分等因素的相关性。结果感染组广谱抗生素和甲强龙使用时间均明显长于对照组(均P<0.05)，血清白蛋白水平明显低于对照组(P<0.05)。广谱抗生素使用21 d以上或联用广谱抗生素和甲强龙14 d以上真菌性肺炎发生率均显著升高(P<0.05)，碳青霉烯类抗生素联用甲强龙14 d以上患者真菌性肺炎发生率显著高于头孢类抗生素或酶抑制剂复合制剂联用甲强龙患者(P<0.05)。 Logistics回归分析显示，COPD并发真菌性肺炎与广谱抗生素和甲强龙使用时间及低蛋白血症密切相关(均P<0.05)。结论长时间使用广谱抗生素或甲强龙、联用碳青霉烯类抗生素和甲强龙14 d以上及低蛋白血症是COPD并发真菌性肺炎的独立危险因素。
목적：탐토만성조새성폐질병(COPD)환자병발진균성폐염적위험인소。방법선택2012년1월~2013년12월주원기간병발진균성폐염적COPD환자65례위감염조，이동기무진균성폐염적COPD주원환자2014례작위대조조，분석COPD병발진균성폐염여엄보항생소충류화료정、시부련용갑강룡、혈청백단백수평급APACHEⅡ평분등인소적상관성。결과감염조엄보항생소화갑강룡사용시간균명현장우대조조(균P<0.05)，혈청백단백수평명현저우대조조(P<0.05)。엄보항생소사용21 d이상혹련용엄보항생소화갑강룡14 d이상진균성폐염발생솔균현저승고(P<0.05)，탄청매희류항생소련용갑강룡14 d이상환자진균성폐염발생솔현저고우두포류항생소혹매억제제복합제제련용갑강룡환자(P<0.05)。 Logistics회귀분석현시，COPD병발진균성폐염여엄보항생소화갑강룡사용시간급저단백혈증밀절상관(균P<0.05)。결론장시간사용엄보항생소혹갑강룡、련용탄청매희류항생소화갑강룡14 d이상급저단백혈증시COPD병발진균성폐염적독립위험인소。
Objective To explore the probable risk factors of nosocomial fungal pneumonia in in-patients with acute exacerbation of chronic pulmonary obstructive diseases (COPD). Methods 65 in-patients with acute exacerbation of COPD complicated by nosocomial fungal pneumonia from January 2012 and December 2013 were selected as infection group, while the other 2014 cases of COPD in-patients without fungal pneumonia were selected as control group during the same period. The relationship of the nosocomial fungal pneumonia in COPD patients with the kinds and use dura-tion of broad-spectrum antibacterials, use of prednisolone, serum albumin level, and APACHEII scores etc., were an-alyzed. Results Both mean use durations of broad-spectrum antibacterials and glucocorticoid in infection group were significantly longer than those in control group (all P<0.05). The mean serum albumin level in infection group was sig-nificantly lower than that in control group (P<0.05). The incidence of fungal pneumonia in patients with use duration of broad-spectrum antibacterial over 21 days or combined use of antibacterial and prednisolone over 14 days was sig-nificantly increased (P< 0.05). Patients with combined use of carbapenems and Prednisolone had higher incidence of fungal pneumonia than those with use of broad-spec-trum cefalosporin or β-lactamase inhibitor compound in combination with Prednisolone (P<0.05). Logistics regression analysis showed that the nosocomial fungal pneumonia in COPD patients was significantly corre-lated with the use durations of broad-spectrum an-tibacterials and Prednisolone, as well as hypoalbumine-mia (all P<0.05). Conclusion Longer use durations of broad-spectrum antibacterial or Prednisolone, combined use of carbapenems and Prednisolone over 14 days as well as hypoalbuminemia might be independent risk factors for the nosocomial fungal pneumonia in in-patients with acute exacerbation of COPD.