呼吸科重症患者肺部真菌感染易感因素及多学科协作下预见性管理干预措施OA
Predisposing factors associated with pulmonary fungal infections in critically ill respiratory patients and their anticipatory management under multidisciplinary collaboration
目的 分析呼吸科重症患者肺部真菌感染(pulmonary fungal infection,PFI)相关易感因素,并探讨多学科协作下的预见性管理干预措施.方法 回顾性纳入 2022 年 5 月—2024 年 5 月于首都医科大学附属北京积水潭医院呼吸科重症监护室接受治疗的 165 例患者为研究对象,根据患者真菌感染情况将其分为 PFI 组(n=54)和非 PFI 组(n=111).收集两组临床资料,分析真菌分布情况,采用 logistic 回归分析呼吸科重症患者继发 PFI 的危险因素,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析预测变量准确性.结果 PFI 组 54 例患者共分离出真菌 67 株,其中白念珠菌 26 株(38.81％).logistic 回归分析显示:年龄、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)、糖尿病、Ⅱ型呼吸衰竭、住院时间、机械通气、侵入性操作、广谱抗生素使用时间>2 周、血沉、IL-1β 是呼吸科重症患者继发 PFI 的独立危险因素(P<0.05);白蛋白、Th17/Treg是其保护因素(P<0.05).ROC曲线结果显示:年龄、APACHE Ⅱ、糖尿病、Ⅱ型呼衰、住院时间、机械通气、侵入性操作、广谱抗生素使用时间>2周、血沉、白蛋白、IL-1β、Th17/Treg及联合预测对于预测呼吸科重症患者继发PFI均具有统计学意义(P<0.05);其中联合预测评估呼吸科重症患者继发 PFI 的曲线下面积(area under the curve,AUC)=0.988,95％CI 为 0.977～0.999,灵敏度为 1.000,特异度为 0.883.结论 呼吸科重症患者继发 PFI 的危险因素主要包括年龄、APACHE Ⅱ、糖尿病、Ⅱ型呼衰、住院时间、机械通气、侵入性操作、广谱抗生素使用时间>2 周、血沉及 IL-1β;ALB 与Th17/Treg 是保护因素.临床治疗呼吸科重症患者需密切关注上述因素,并制定个性化预见性管理干预措施,以降低 PFI的发生率.
Objective To analyse the predisposing factors associated with pulmonary fungal infections(PFI)in critically ill respiratory patients and to explore anticipatory management interventions under multidisciplinary collaboration.Methods A total of 165 patients treated in respiratory intensive care unit(RICU)of Beijing Ji shui tan Hospital from May 2022 to May 2024 were retrospectively included in the study,and the patients were divided into the PFI group(n=54)and the non-PFI group(n=111)according to their fungal infection status.The clinical data of the two groups were collected,the fungal distribution of the patients in the PFI group was analysed,the risk factors for secondary PFI in respiratory intensive care patients were analysed by logistic regression,the predictive model was established by the probability values fitted to the regression equations,and the accuracy of the predictive variables was analysed by plotting the ROC curves.Results A total of 67 strains of fungi were isolated from 54 patients in the PFI group,including 26 strains of Candida albicans,accounting for 38.81％.Logistic regression analysis showed that age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,length of hospital stay,mechanical ventilation,invasive operations,use of broad-spectrum antibiotics for>2 weeks,ESR,and IL-1β were the independent risk factors for secondary PFI in respiratory critically ill patients(P<0.05);and ALB and Th17/Treg were the protective factors for it(P<0.05)The results of ROC curves showed that age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,length of hospital stay,mechanical ventilation,invasive operation,use of broad-spectrum antibiotics for>2 weeks,ESR,ALB,IL-1β,Th17/Treg,and the combined prediction were statistically significant in predicting secondary PFI in respiratory critically ill patients(P<0.05);in which the combined prediction assessment secondary PFI in respiratory intensive care patients had an AUC=0.988,95％CI 0.977-0.999,sensitivity 1.000,and specificity 0.883.Conclusion Age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,hospital stay,mechanical ventilation,invasive operation,broad-spectrum antibiotic use>2 weeks,ESR,and IL-1β were the ALB,Th17/Treg are the protective factors.Clinical treatment of respiratory critically ill patients should pay close attention to the assessment of the above factors and develop personalised anticipatory management interventions under multidisciplinary collaboration to reduce the incidence of PFI.
赵晶晶;孙振芳;王菲;孟姣
首都医科大学附属北京积水潭医院呼吸与危重症医学科,北京 102208首都医科大学附属北京积水潭医院呼吸与危重症医学科,北京 102208首都医科大学附属北京积水潭医院呼吸重症监护室,北京 102208首都医科大学附属北京积水潭医院呼吸与危重症医学科,北京 102208
肺部真菌感染呼吸科重症患者预见性管理干预措施多学科协作易感因素
pulmonary fungal infectionrespiratory intensive care patientsanticipatory management interventionsmultidisciplinary collaborationpredisposing factors
《中国真菌学杂志》 2026 (2)
160-166,7
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