目的 分析发生侵袭性肺部真菌感染（IPFI）的危险因素，为早期防治IPFI 提供理论依据。方法 采用回顾性病例对照研究方法，对2012 年1 月至2013 年3 月儿科重症监护病房住院的48 例符合IPFI临床诊断的患儿和同期住院的不符合IPFI 临床诊断的106 例肺炎患儿的临床资料进行对照分析，应用非条件多因素logistic 回归分析明确IPFI 发生的主要危险因素。结果 真菌感染组的平均年龄、血清白蛋白水平低于非真菌感染组（P<0.01）；真菌感染组的平均住院时间、抗生素和糖皮质激素使用时间长于非真菌感染组（P<0.01）；真菌感染组的营养不良、有创机械通气、体内留置导管使用、口咽部真菌感染、并发腹泻等的比率高于非真菌感染组（P<0.05）。多因素logistic 回归分析显示：有创机械通气、腹泻、糖皮质激素使用时间、抗生素使用时间、年龄、血清白蛋白水平是发生IPFI 的独立危险因素。结论 临床怀疑婴幼儿IPFI 而相关病原学检查困难，如果存在有创机械通气、腹泻、长时间使用广谱抗生素和糖皮质激素、低血清白蛋白血症等高危因素时，应及时考虑IPFI 的可能，尽早开展经验性抗真菌治疗。
Abstract
Objective To analyze the risk factors for invasive pulmonary fungal infection (IPFI) and to provide a theoretical basis for the early prevention and treatment of IPFI. Methods A retrospective case-control study was conducted on the clinical data of children hospitalized in the pediatric intensive care unit between January 2012 and March 2013. These children consisted of 48 patients with a clinical diagnosis of IPFI (IPFI group) and 106 pneumonia patients without a clinical diagnosis of IPFI (non-IPFI group). The clinical date of the two groups were compared and analyzed. The main risk factors for the development of IPIF were identified by unconditional multivariate logistic regression analysis. Results Compared with the non-IPIF group, the IPIF group had significantly lower mean age and serum albumin level (P<0.01), significantly longer mean length of hospital stay, duration of antibiotic use, and duration of corticosteroid use (P<0.01), and significantly higher rates of malnutrition, invasive mechanical ventilation, indwelling catheter use, oropharyngeal fungal infection, and diarrhea (P<0.05). Multivariate logistic regression analysis showed that invasive mechanical ventilation, diarrhea, long duration of corticosteroid use, long duration of antibiotic use, young age, and low serum albumin level were independent risk factors for the development of IPFI. Conclusions For the infants with suspected IPFI for whom pathogenic examination is difficult to perform, IPFI should be considered in cases of invasive mechanical ventilation, diarrhea, long-time uses of broad-spectrum antibiotics and corticosteroids and hypoalbuminemia, and empirical antifungal therapy should be performed as soon as possible.
关键词
侵袭性肺部真菌感染 /
危险因素 /
儿童
Key words
Invasive pulmonary fungal infection /
Risk factor /
Child
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