摘要
目的:探讨肺移植术后侵袭性真菌感染的危险因素及对术后早期死亡风险的影响,以期为降低真菌感染的发生率及预防术后早期死亡提供依据。方法:回顾性纳入南京医科大学附属无锡人民医院肺移植中心2019年1月至2020年12月行肺移植手术的291例患者为研究对象,收集术后30 d内真菌感染发生情况,及供-受体、随访资料,采用单因素及多因素二分类非条件Logistic回归探索真菌感染发生的影响因素,通过Kaplan-Meier法和多因素Cox回归分析真菌感染对其术后死亡风险的影响。结果:肺移植受者术后30 d内真菌感染率为13.4%(39/291)。肺部原发病是影响术后早期真菌感染的因素,与尘肺相比,继发性肺间质纤维化(OR=9.957,95%CI:1.244~79.685,P=0.030)、特发性肺间质纤维化(OR=7.548,95%CI:0.948~60.119,P=0.056)发生感染的风险更高。生存分析显示,术后早期真菌感染对30 d(HR=2.86,95%CI:0.868~9.419)、90 d(HR=1.272,95%CI:0.618~2.619)、180 d(HR=1.198,95%CI:0.681~0.626)及1年(HR=1.206,95%CI:0.680~2.139)的死亡风险影响均无统计学意义。结论:肺间质纤维化患者移植术后易发生早期真菌感染,但尚未观察到肺移植受者术后早期真菌感染会造成术后早期死亡风险的增加。
Objective:To investigate the risk factors of invasive fungal infections and impact of early death after lung transplantation,so as to provide evidence for reducing the incidence of fungal infections and early death.Methods:A total of 291 patients who underwent lung transplantation in the Lung Transplant Center of Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2019 to December 2020 were retrospectively included in the study.The occurrence of fungal infection within 30 days after surgery,donor-recipient and follow-up data were collected.Univariate and multivariate binary unconditional logistic regression were used to explore the influencing factors of fungal infection.Kaplan-Meier method and multivariate Cox regression were used to analyze the influence of fungal infection on the risk of postoperative death.Results:The rate of fungal infection within 30 days after lung transplantation was 13.4%(39/291).Primary pulmonary disease was an important factor affecting early postoperative fungal infection.Compared with pneumoconiosis,secondary pulmonary interstitial fibrosis(OR=9.957,95%CI:1.244-79.685,P=0.030)and idiopathic pulmonary interstitial fibrosis(OR=7.548,95%CI:0.948-60.119,P=0.056)had a higher risk of infection.Survival analysis showed that early postoperative fungal infection was more effective in 30 days(HR=2.86,95%CI:0.868-9.419),90 days(HR=1.272,95%CI:0.618-2.619)and 180 days(HR=1.198,95%CI:0.681-0.626)and 1-year(HR=1.206,95%CI:0.680-2.139)mortality risk were not statistically significant.Conclusion:Patients with pulmonary interstitial fibrosis are prone to early fungal infections after transplantation,but an increase in early death has not been found in lung transplant recipients with early fungal infections.
作者
王文静
李小杉
钱婷
杨航
陈静瑜
吴波
WANG Wenjing;LI Xiaoshan;QIAN Ting;YANG Hang;CHEN Jingyu;WU Bo(Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)
出处
《东南大学学报（医学版）》
CAS
2023年第1期132-139,共8页
Journal of Southeast University(Medical Science Edition)
基金
无锡市卫生计生委精准医疗项目(jzyx02)
2020太湖人才计划高端人才项目(2020THRC-GD-8)
无锡市卫生健康委青年项目(Q202003)。
关键词
肺移植
侵袭性真菌感染
危险因素
早期死亡风险
lung transplantation
invasive fungal infections
risk factors
impact of early death
