冠心病合并COPD患者继发肺部真菌感染的菌种分布及易感因素分析

Fungal species distribution and susceptibility factors analysis of secondary pulmonary fungal infections in patients with coronary heart disease combined with COPD

摘要:

目的]探讨冠心病合并慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的菌种分布及相关易感因素。 [方法]回顾性选取本院2021年3月—2024年6月收治的68例冠心病合并COPD继发肺部真菌感染病例(设为感染组),经合格痰标本及肺泡灌洗液病原学鉴定确诊,同时以1∶1比例随机纳入单纯冠心病合并COPD病例68例,设为未感染组。收集两组患者临床资料,利用Logistic回归模型分析冠心病合并COPD患者继发肺部真菌感染的易感因素,经受试者工作特征(ROC)曲线评估预测指标的诊断效能。 [结果]68例冠心病合并COPD继发肺部真菌感染患者,共检出76株真菌,其中白念珠菌48株(63.16%)。多因素Logistic回归分析显示,住院时间(OR＝0.160)、抗生素使用时间(OR＝0.221)、侵入性操作(OR＝0.248)、合并低蛋白血症(OR＝0.104)、合并糖尿病(OR＝0.269)及合并肺结核(OR＝0.199)是冠心病合并COPD患者继发肺部真菌感染的易感因素(P＜0.05)。ROC曲线结果显示,住院时间、合并低蛋白血症、合并糖尿病及三者联合评估冠心病合并COPD患者继发肺部真菌感染的曲线下面积(AUC)分别为0.610(95%CI:0.515~0.705)、0.647(95%CI:0.554~0.740)、0.603(95%CI:0.508~0.698)和0.843(95%CI:0.776~0.911),与ROC曲线下方所覆盖的面积为0.5相比,均有统计学意义(P＜0.05)。 [结论]冠心病合并COPD患者继发肺部真菌感染,其病原菌以白念珠菌为主。住院时间、抗生素使用时间、侵入性操作、合并低蛋白血症、合并糖尿病及合并肺结核是冠心病合并COPD患者继发肺部真菌感染的易感因素。

Abstract:

Aim To investigate fungal species distribution and associated susceptibility factors of secondary pulmonary fungal infections in patients with coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD). Methods A total of 68 patients with CHD combined with COPD who developed secondary pulmonary fungal infections were retrospectively selected from those admitted to our hospital from March 2021 to June 2024 as the infected group, and the diagnosis was confirmed by pathogenic identification of qualified sputum specimens and alveolar lavage fluid, while 68 patients with simple CHD combined with COPD were randomly included in the ratio of 1∶1, and were set up as the uninfected group. Clinical data of patients in both groups were collected, Logistic regression model was used to analyze the susceptible factors of secondary pulmonary fungal infection in patients with CHD combined with COPD. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy and accuracy of predictive indicators. Results In 68 patients with CHD combined with COPD secondary to pulmonary fungal infections, 76 strains of fungi were detected, including 48 strains of Candida albicans (63.16%). Multivariate Logistic regression analysis revealed that hospital days (OR＝0.160), duration of antibiotic use (OR＝0.221), invasive operations (OR＝0.248), combined hypoproteinemia (OR＝0.104), combined diabetes mellitus (OR＝0.269), and combined pulmonary tuberculosis (OR＝0.199) were the susceptible factors for secondary pulmonary fungal infection in patients with CHD combined with COPD (P＜0.05). The results of the ROC curve showed that the area under the curve (AUC) of hospital days, combined hypoproteinemia, combined diabetes and combined detection for evaluating pulmonary fungal infection in patients with CHD combined with COPD were 0.610 (95%CI:0.515~0.705), 0.647 (95%CI:0.554~0.0,0.603 (95%CI:0.508~0.698) and 0.843 (95%CI:0.776~0.911), respectively, which were all statistically significant compared with the area covered under the ROC curve of 0.5 (P＜0.05). Conclusion The pathogen of secondary pulmonary fungal infection is mainly Candida albicans in patients with CHD combined with COPD. Hospital days, duration of antibiotics, invasive operations, combined hypoproteinemia, combined diabetes mellitus, and combined pulmonary tuberculosis were risk factors of secondary pulmonary fungal infection in patients with CHD combined with COPD.