标题：高龄急性脑卒中伴下呼吸道真菌感染临床分析

      作者：王维 1，何娟 1，任芳芳 2    (西安市北方医院老年病科 1、呼吸科 2，陕西 西安 710043)

      卷次： 2018年29卷4期

      【摘要】 目的 分析高龄急性脑卒中患者下呼吸道真菌感染、定植真菌的临床特点和危险因素，为预防措施提供参考依据。方法 选取2014年5月至2017年5月西安市北方医院老年病科收治的高龄脑卒中伴真菌感染患者120例为研究对象，分析真菌感染部位、下呼吸道真菌感染真菌分布特点及真菌定植病原学特征，同时分析急性脑卒中合并下呼吸道真菌定植的影响因素及危险因素，并提出针对预防措施。结果 120例急性脑卒中患者的真菌感染标本中，真菌感染部位主要包括下呼吸道感染113例(94.17%)、血液感染4例(3.33%)、颅内感染3例(2.50%)；下呼吸道真菌感染的真菌类型以假丝酵母菌属(82.97%)、曲霉菌属(17.03%)为主，假丝酵母菌属以白色假丝酵母菌最多(37.91%)，曲霉菌属以烟曲霉菌为主(12.64%)；下呼吸道真菌感染患者中共30例出现真菌定植，真菌定植率为26.55%，其中假丝酵母菌属占 70.00%，曲霉菌属占 30.00%；真菌定植患者年龄[(79.21±1.04)岁]、住院时间[(5.33±0.17) d]、侵入性操作比例(86.7%)、1年内应用抗菌药物比例(83.3%)、病情加重率(56.7%)、病死率(13.3%)，明显高于未出现真菌定植者，差异均有统计学意义(P<0.05)；Logistic回归分析显示，住院时间、年龄、1年内应用抗菌药物是影响高龄脑卒中患者下呼吸道真菌定植的独立危险因素(P<0.05)。结论 高龄急性脑卒中患者下呼吸道真菌感染菌属以假丝酵母菌属、曲霉菌属为主，住院时间、年龄、1年内应用抗菌药物是导致真菌定植感染的独立危险因素，临床应采取相应预防措施降低感染率。
      【关键词】 高龄；急性脑卒中；下呼吸道；真菌感染；临床特点
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2018）04—0473—04

Clinical analysis of elderly acute ischemic stroke complicated with fungal infection of lower respiratory tract.WANG Wei 1, HE Juan 1, REN Fang-fang 2.
Department of Geriatrics 1, Department of Respiration 2, the Northern Hospital ofXi'an, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To analyze the clinical features and risk factors of lower respiratory tract fungal infec-tion and colonization in elderly patients with acute ischemic stroke (AIS), so as to provide reference for preventive mea-sures. Methods A total of 120 elderly patients with AIS complicated with fungal infection treated in Department of Ge-riatrics in the Northern Hospital of Xi'an from May 2014 to May 2017 were selected as research objects. The fungal in-fection areas and pathogen distribution of lower respiratory tract fungal infection were analyzed. At the same time, the in-fluencing factors and risk factors of AIS complicated with lower respiratory tract fungal colonization were analyzed, andthe preventive measures were put forward. Results Among the fungal infection specimens in the 120 patients with AIS,there were lower respiratory tract infections in 113 cases (94.17%), blood infections in 4 cases (3.33%), and intracranialinfections in 3 cases (2.50%). The pathogens of lower respiratory tract fungal infection were mainly Candida (82.97%)and Aspergillus (17.03%), dominated by Candida albicans (37.91%) and Aspergillus fumigatus (12.64%), respectively.Among the 113 patients with lower respiratory tract fungal infections, 30 (26.55%) were found with fungal colonization,with Candida accounting for 70.00% and Aspergillus accounting for 30.00%. The age, years, length of hospital stay, inva-sive operation rate, the use rate of antimicrobial agents within 1 year, exacerbation rate, and fatality rate were (79.21±1.04), (5.33±0.17) d, 86.7%, 83.3%, 56.7%, 13.3% in patients with fungal colonization, which were significantly higherthan those in patients without fungal colonization (P<0.05). Logistic regression analysis showed that length of hospitalstays, age, and the use rate of antimicrobial agents within 1 year were the independent risk factors for lower respiratorytract fungal colonization in elderly patients (P<0.05). Conclusion Lower respiratory tract fungal infections in the el-derly patients with AIS are mainly caused by Candida and Aspergillus. The length of hospital stay, age, and the use rateof antimicrobial agents within 1 year are the independent risk factors for fungal colonization. Appropriate preventivemeasures should be taken to reduce the infection rate in the clinical application.
      【Key words】 Elderly; Acute ischemic stroke (AIS); Lower respiratory tract; Fungal infection; Clinical features·论 著·doi:10.3969/j.issn.1003-6350.2018.04.009