实用心脑肺血管病杂志
實用心腦肺血管病雜誌
실용심뇌폐혈관병잡지
PRACTICAL JOURNAL OF CARDIAC CEREBRAL PNEUMAL AND VASCULAR DISEASE
2015年
5期
43-46
,共4页
糖尿病,2型%肺%结核%医院获得性肺炎%危险因素
糖尿病,2型%肺%結覈%醫院穫得性肺炎%危險因素
당뇨병,2형%폐%결핵%의원획득성폐염%위험인소
Diabetes mellitus,type 2%Lung%Tuberculosis%Hospital-acquired pneumonia%Risk factos
目的：探讨老年2型糖尿病肺结核患者合并医院获得性肺炎（ HAP）的危险因素，为临床防治肺部感染提供参考。方法选择2011年2月—2014年2月邢台市第二医院收治的老年2型糖尿病肺结核合并HAP患者92例作为病例组，采用1：2配对的病例对照研究方法，选取同期收治的未合并HAP的老年2型糖尿病肺结核患者184例作为对照组。制定统一表格，收集两组患者入院时临床资料、影像学资料、痰抗酸杆菌涂片及血清抗结核抗体检测情况、感染前红细胞沉降率（ ESR）、空腹血糖、糖化血红蛋白、餐后2 h血糖、营养状况（血红蛋白及血清清蛋白）及住院时间等，并分析病例组患者病原菌分布情况。老年2型糖尿病肺结核患者合并HAP的危险因素分析采用单因素分析及二分类Logistic回归分析。结果病例组患者分离出104株病原菌，其中革兰阴性杆菌占63.4%、革兰阳性菌占22.1%、真菌占14.4%。二分类Logistic回归分析结果显示，年龄>70岁〔OR =1.738，95%CI（1.578，4.256）〕、肺结核病程>5年〔OR =2.114，95%CI（1.370，4.211）〕、空洞数量≥3个肺野〔OR =2.267，95%CI（2.015，7.232）〕、有合并症〔OR =2.310，95%CI（2.145，5.452）〕、餐后2 h 血糖≥11.0 mmol/L〔OR =1.335，95%CI （1.182，1.894）〕是老年2型糖尿病肺结核患者合并HAP的危险因素。结论年龄>70岁、肺结核病程>5年、空洞数量≥3个肺野、有合并症及餐后2 h血糖≥11.0 mmol/L是老年2型糖尿病肺结核患者合并HAP的独立危险因素，临床上应针对以上危险因素加强感染控制措施以降低HAP发生率。
目的：探討老年2型糖尿病肺結覈患者閤併醫院穫得性肺炎（ HAP）的危險因素，為臨床防治肺部感染提供參攷。方法選擇2011年2月—2014年2月邢檯市第二醫院收治的老年2型糖尿病肺結覈閤併HAP患者92例作為病例組，採用1：2配對的病例對照研究方法，選取同期收治的未閤併HAP的老年2型糖尿病肺結覈患者184例作為對照組。製定統一錶格，收集兩組患者入院時臨床資料、影像學資料、痰抗痠桿菌塗片及血清抗結覈抗體檢測情況、感染前紅細胞沉降率（ ESR）、空腹血糖、糖化血紅蛋白、餐後2 h血糖、營養狀況（血紅蛋白及血清清蛋白）及住院時間等，併分析病例組患者病原菌分佈情況。老年2型糖尿病肺結覈患者閤併HAP的危險因素分析採用單因素分析及二分類Logistic迴歸分析。結果病例組患者分離齣104株病原菌，其中革蘭陰性桿菌佔63.4%、革蘭暘性菌佔22.1%、真菌佔14.4%。二分類Logistic迴歸分析結果顯示，年齡>70歲〔OR =1.738，95%CI（1.578，4.256）〕、肺結覈病程>5年〔OR =2.114，95%CI（1.370，4.211）〕、空洞數量≥3箇肺野〔OR =2.267，95%CI（2.015，7.232）〕、有閤併癥〔OR =2.310，95%CI（2.145，5.452）〕、餐後2 h 血糖≥11.0 mmol/L〔OR =1.335，95%CI （1.182，1.894）〕是老年2型糖尿病肺結覈患者閤併HAP的危險因素。結論年齡>70歲、肺結覈病程>5年、空洞數量≥3箇肺野、有閤併癥及餐後2 h血糖≥11.0 mmol/L是老年2型糖尿病肺結覈患者閤併HAP的獨立危險因素，臨床上應針對以上危險因素加彊感染控製措施以降低HAP髮生率。
목적：탐토노년2형당뇨병폐결핵환자합병의원획득성폐염（ HAP）적위험인소，위림상방치폐부감염제공삼고。방법선택2011년2월—2014년2월형태시제이의원수치적노년2형당뇨병폐결핵합병HAP환자92례작위병례조，채용1：2배대적병례대조연구방법，선취동기수치적미합병HAP적노년2형당뇨병폐결핵환자184례작위대조조。제정통일표격，수집량조환자입원시림상자료、영상학자료、담항산간균도편급혈청항결핵항체검측정황、감염전홍세포침강솔（ ESR）、공복혈당、당화혈홍단백、찬후2 h혈당、영양상황（혈홍단백급혈청청단백）급주원시간등，병분석병례조환자병원균분포정황。노년2형당뇨병폐결핵환자합병HAP적위험인소분석채용단인소분석급이분류Logistic회귀분석。결과병례조환자분리출104주병원균，기중혁란음성간균점63.4%、혁란양성균점22.1%、진균점14.4%。이분류Logistic회귀분석결과현시，년령>70세〔OR =1.738，95%CI（1.578，4.256）〕、폐결핵병정>5년〔OR =2.114，95%CI（1.370，4.211）〕、공동수량≥3개폐야〔OR =2.267，95%CI（2.015，7.232）〕、유합병증〔OR =2.310，95%CI（2.145，5.452）〕、찬후2 h 혈당≥11.0 mmol/L〔OR =1.335，95%CI （1.182，1.894）〕시노년2형당뇨병폐결핵환자합병HAP적위험인소。결론년령>70세、폐결핵병정>5년、공동수량≥3개폐야、유합병증급찬후2 h혈당≥11.0 mmol/L시노년2형당뇨병폐결핵환자합병HAP적독립위험인소，림상상응침대이상위험인소가강감염공제조시이강저HAP발생솔。
Objective To investigate the risk factors of hospital acquired pneumonia( HAP) in elderly tuberculosis patients complicated with type 2 diabetes mellitus( T2DM),to provide references for clinical prevention and treatment of pulmonary infection. Methods From February 2011 to February 2014,a total of 92 tuberculosis patients complicated with T2DM and HAP were selected as case group in the Second Hospital of Xingtai,and 184 tuberculosis patients complicated with T2DM were selected as control group according to 1:2 matched case - control study method. Clinical data,imaging data, sputum smear for acid-fast bacillus,tubercle bacillus antibodies,ESR before infection,FPG,HbA1c,2 h FPG,Hb,ALB and hospital stays of the two groups were collected, pathogenic bacteria distribution of case group was analyzed. Univariate analysis and binary Logistic regression analysis were used to analyze the risk factors of HAP in elderly tuberculosis patients complicated with T2DM. Results A total of 104 strains of pathogenic bacteria were isolated in case group,including gram-negative bacilli(63. 4%),gram-positive cocci(22. 1%) and fungus(14. 4%). Binary Logistic regression analysis showed that,age>70 years old〔OR=1. 738,95%CI(1. 578,4. 256)〕,course of tuberculosis>5 years〔OR=2. 114,95%CI (1. 370,4. 211)〕,pulmonary fields tuberculous cavity≥3〔OR = 2. 267,95% CI(2. 015,7. 232)〕,occurrence of complications〔OR = 2. 310,95% CI(2. 145,5. 452)〕,2 h FPG≥11. 0 mmol/L〔OR = 1. 335,95% CI(1. 182, 1. 894)〕were risk factors of HAP in elderly tuberculosis patients complicated with T2DM. Conclusion Age>70 years old, course of tuberculosis>5 years,pulmonary fields tuberculous cavity≥3,occurrence of complications,2 h FPG≥11. 0 mmol/L are risk factors of HAP in elderly tuberculosis patients complicated with T2DM,and targeted infection control measures should be made according to above risk factors,to reduce the incidence of HAP.
