发热伴血小板减少综合征并发侵袭性肺曲霉病的危险因素分析

doi:10.19871/j.cnki.xfcrbzz.2024.05.008

摘要/Abstract

摘要： 目的探究发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome,SFTS）继发侵袭性肺曲霉病（invasive pulmonary aspergillosis,IPA）的相关危险因素。方法收集南京市第二医院自2020年1月至2023年11月确诊为SFTS的患者109例,发生IPA的14例,未发生IPA的95例。比较两组间的一般资料、炎症与免疫指标、脏器损害程度。结果 109例患者均为散发病例,男性50例,女性59例,发病年龄中位数为68岁。单因素分析中,未发生IPA组的降钙素原、C反应蛋白、血清白介素6、CD3⁺T淋巴细胞、CD4⁺T淋巴细胞、CD45淋巴细胞水平以及接受机械通气（mechanical ventilation,MV）、血液净化、血管活性药物治疗的比例均低于发生IPA组,而血清白蛋白水平高于发生IPA组,差异均有统计学意义（均P<0.05）。经多因素Logistic回归分析发现血清白蛋白水平及MV治疗是发生IPA的影响因素（P<0.05）,其中血清白蛋白水平升高（OR=0.78）是发生IPA的保护因素,接受MV治疗(OR=9.80)是发生IPA的危险因素。受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）多指标联合分析发现接受MV治疗联合血清白蛋白水平下降可用于临床预测IPA的发生[曲线下面积（area under curve,AUC）=0.845]。结论 MV治疗及血清白蛋白水平是发生IPA的独立影响因素,可单独及联合用于临床预测SFTS患者IPA的发生,进而为IPA的预防、早期抗真菌治疗及降低病死率提供临床参考。

关键词: 发热伴血小板减少综合征, 侵袭性肺曲霉病, 机械通气, 血清白蛋白

Abstract: Objective To explore the risk factors associated with Invasive Pulmonary Aspergillosis（IPA） secondary to Severe fever with thrombocytopenia syndrome（SFTS）through retrospective analysis. Method A total of 109 patients with SFTS were confirmed in the Second Hospital of Nanjing from January 2020 to November 2023. There were 14 cases with IPA and 95 cases without IPA. SPSS 26.0 was used for univariate and multivariate analysis, general data, inflammatory and immune indicators, and degree of organ damage between the two groups were compared. Result All 109 patients were sporadic, 50 males and 59 females, with a median age of onset of 68 years. In univariate analysis, the levels of procalcitonin, C-reactive protein, serum interleukin 6, CD3⁺T lymphocytes, CD4⁺T lymphocytes and CD45 lymphocytes in the IPA group, as well as the proportion of mechanical ventilation, blood purification and vasoactive drug treatment in the none-IPA group were lower than those in the IPA group (P<0.05), while the serum albumin levels in the none-IPA group were significantly higher than those in the IPA group (P<0.05). Logistic regression analysis showed that serum albumin and mechanical ventilation were influencing factors for IPA (P<0.05), serum albumin level (odds ratio=0.78) was a protective factor for the development of IPA, and mechanical ventilation therapy (odds ratio=9.80) was a risk factor for the development of IPA. ROC multiplex analysis showed that the combination of mechanical ventilation and a decrease in serum albumin levels could be used to predict the occurrence of IPA (AUC=0.845). Conclusion mechanical ventilation and decreased serum albumin levels are independent risk factors for the development of IPA, which can be used alone or in combination to predict the occurrence of IPA in patients with SFTS. In addition, it provides a clinical reference for preventing the occurrence of IPA, preemptive antifungal therapy, and reducing the mortality rate.

Key words: Severe fever with thrombocytopenia syndrome, Invasive pulmonary Aspergillosis, Mechanical ventilation, Serum albumin

中图分类号:

R512.8

陈军, 肖玲燕, 史东阳, 刘永福, 杨凯, 崔大广, 郑以山. 发热伴血小板减少综合征并发侵袭性肺曲霉病的危险因素分析[J]. 新发传染病电子杂志, 2024, 9(5): 42-46.

Chen Jun, Xiao Lingyan, Shi Dongyang, Liu Yongfu, Yang Kai, Cui Daguang, Zheng Yishan. Analysis of risk factors for invasive pulmonary aspergillosis secondary to fever with thrombocytopenia syndrome[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(5): 42-46.

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