摘要
目的通过回顾性分析结缔组织病相关间质性肺病（CTD—ILD）合并肺部感染的临床特点，探讨其危险因素。方法分析219例CTD-ILD住院患者的临床资料，根据有无合并肺部感染分为感染组（A组）和无合并感染组（B组），比较两组临床及实验室等指标差异，分析其相关性。结果（1）CTD—ILD合并肺部感染发生率为43．38％（95／219例），其中多发性肌炎／皮肌炎（PM／DM）、系统性红斑狼疮（SLE）和系统性血管炎（SV）最为多见；A组出现呼吸衰竭明显高于B组（P〈0．05），死亡5例，均为感染组。（2）A组发热、咳痰；血中性粒细胞、红细胞沉降率（ESR）、C反应蛋白（CRP）及铁蛋白升高；中重度限制性通气障碍及大剂量激素使用均明显高于B组且与肺部感染呈正相关（P均（0．05）；淋巴细胞数、白蛋白和血氧分压（PO：）明显低于B组，与肺部感染呈负相关（P均〈0．05）；两组肺部HRCT表现无明显差异（P〉0．05）。（3）病毒感染22例（23．2％），痰培养阳性率18例（18．9％，革兰氏阴性杆菌14例、真菌4例）。（4）Logistic多元回归分析：咳嗽咳痰、CRP升高、淋巴细胞及白蛋白降低是诊断CTD—ILD合并肺部感染的危险因素（P均〈0．05）。结论CTD—ILD易合并肺部感染，且明显增加肺功能损伤、呼吸衰竭及死亡的发生。淋巴细胞减少、白蛋白降低及CRP升高是合并感染的独立危险因素。
Objective To explore the risk factors of CTD-ILD with lung infection, the clinical characteristics were retrospectively analyzed. Methods Two hundred and nineteen CTD-ILD patients were chosen and divided into infection group （ group A） and non-infection group （ group B） according to whether pulmonary infection existed. Compared two groups of clinical and laboratory index differences, such as analysised of the correlation. Results （ 1 ） Among 219 patients, the prevalence of pulmonary infection in CTD-ILD was 43.38% （95/219 cases）. The top 3 of disease were PM/DM,SLE,SV. Five dead patients all belonged to Group A. （2） These clinical characteristics in group A were significantly higher than group B,including the increased of neutrophilic granulocyte, ESR, CRP, serum ferritin, and the incidence of fever, expectoration, moderate/severe restrictive ventilatordys dysfunction, use of high doses of glucocorticoid, those were positively related to pulmonary infection（P 〈 0.05 ）. Blood lymphocytes, albumin and PO2 in group A were significantly lower than those in group B, those were negatively related to pulmonary infection（P 〈 0.05 ）. HRCT lesions showed that there were no statistical difference between two groups （ P 〉 0. 05 ）. （ 3 ） 22 cases virus infection （ 23.2% ）, 18 cases sputum culture positive （ 18.9 %, 14 Gram-negative bacillus cases, 4 fungal infection cases ）. （4）Logistic multiple regression analysis showed that CTD-ILD complicated pulmonary infection（ P 〈 0.05 ） was significantly related to cough and expectoration, CRP,lymphocytes and albumin. Conclusion Patients with CTD-ILD were easy to merge lung infection, which significantly increased the occurrence of lung function damage, respiratory failure and death,low albumin and high CRP were independent risk factors for infection.
出处
《临床内科杂志》
CAS
2016年第2期124-127,共4页
Journal of Clinical Internal Medicine
关键词
结缔组织病
间质性肺病
肺部感染
Connective tissue disease
Interstitial pneumonia
Pulmonary infection
