侵袭性肺曲霉病的预后因素分析.docx

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1、侵袭性肺曲霉病的预后因素分析侵袭性肺曲霉病的预后因素分析徐思成，郭新红，桑晓红，董旭南摘要目的：探讨侵袭性肺曲霉病(IPA)的预后因素。方法：回顾性分析近5年我们诊断的成人IPA患者的临床资料，并且诊断符合2008年欧洲癌症探讨治疗组织/真菌病探讨组(E0RTC/MSG)的定义标准。CT特征由两位从事胸部CT的高年医生解读患者的初次胸部CT表现，用标准的词汇术语对异样影像进行分类。对可能的临床因素和CT特征进行预后的单因素和1.ogistic回来分析。结果：有65例符合目前IPA的诊断标准，23例(35%)确诊，42例(65%)临床诊断。单因素分析显示，肺外感染、基础疾病限制差和有创机械通气与

2、3个月死亡相关(p0.05)。1.ogistic回来分析显示，基础疾病限制差和有创机械通气与3个月死亡相关(p0.05).结论：基础疾病限制差和有创机械通气与IPA患者的预后独立相关,没有一个CT特征可以提示患者预后。关键词侵袭性肺曲霉病：免疫抑制；计算机断层，线:预后Ana1.ysisofprognosticfactorsofinvasivepu1.monaryaspergi1.osisSi-chengXu.DivisionofCritica1.CareMedicine,the1stAffi1.iatedHospita1.,XinjiangMedica1.University,Mountai

3、n1.iYuStreet,1,Urumqi830054,P.R.China.Correspondingauthor:Si-chengXu,xu_sichengyahooAbstractObjectives:Toana1.yzeprognosticfactorsofinvasivepu1.monaryaspergi1Iosis（IPA）.Methods:A1.1.adu1.tpatientsduringa5-yearwhometthecriteriaforprovenorprobab1.eIPAaccordingtothe2008EORTC/MSGcriteriawereretrospectiv

4、e1.yeva1.uated.Theinitia1.CTfindingsofourpatientswerereviewedbytwoexperiencedradio1.ogica1.physicianswhoworkedoninchestradio1.ogy.Univariateand1.ogisticregressionana1.ysisonpossib1.ec1.inica1.factorsandCTfindingsinthesepatientswereperformedrespective1.y.作者单位：新疆医科高校第一附属医院重症医学科（徐思成），血液科（郭新红），肾病科（桑晓红），

5、一般内科（董旭南）通讯作者：徐思成，830054,乌鲁木齐市鲤鱼山路1号，xu_sichengResu1.ts:Atota1.of65patientswereinc1.uded,consistingof23（35%）provenand42（65%）probab1.epatients.Univariateana1.ysisshowedextra-pu1.monaryinfection,uncontro1.1.edunder1.yingdiseaseandinvasivemechanica1.ventiIationwereassociatedwith3-monthmorta1.ity(p0.05,

6、respective1.y).1.ogisticregressionana1.ysisrevea1.eduncontro1.1.edunder1.yingdiseasesandinvasivemechanica1.venti1.ationwereindependent1.yassociatedwith3-monthmorta1.ity(p005）,但两组APACHEI1.评分有统计学差异（12对9,p0.05）。两组的死亡嫁由均与IP有关。我们分析了65例患者3个月死亡的危急因素，显示肺外感染、基础疾病差和有创机械通气与3个月死亡数相关（p0.05）（见表1）。多因素分析显示，基础疾病差和有创

7、机械通气与3个月死亡数独立相关（p7d)8(36.4)15(34.9)0.938(0.321-2.737)0.906粒细胞严峻削减0(0)3(7)1.075(0.991-1.167)0.545肺外感染3(13.6)0(0)0.864(0.732-1.020)0.035APACHEII评分(13)7(31.8)11(25.6)0.737(0.238-2.278)0.595基础疾病限制差11(50)2(4.7)0.049(0.009-0.253)0.000运用有创通气15(68.2)0(0)0.318(0.1730.587)0.000运用无创通气a6(27.3)16(37.2)1.580(0.51

8、4-4.861)0.423实变、块影7(31.8)10(23.3)0.649(0.207-2.036)0.457大结节b(直径ICn)10(45.5)20(46.5)1,043(0.372-2.926)0.936梗死状结节2(9.1)7(16.3)1.944(0.368-10.266)0.427晕轮征7(31.8)14(32.6)1.034(0.344-3.110)0.952磨玻璃征(GGO)6(27.3)14(32.6)1.287(0.414-4.003)0.662小结节(直径V1.Cn1.)6(27.3)8(18.6)0.61(0.181-2.049)0.421中心低密度征1(4.5)4(

9、9.3)2.154(0.226-20.529)0.496空洞3(13.6)6(14)1.027(0.231-4.567)0.972新月征2(9.1)4(9.3)1.026(0.173-6.087)0.978小气道表现2(9.1)2(4.7)0.488(0.064-3.72)0.481支气管扩张、壁增厚2(9.1)0(0)0.909(0.797-1.038)0.111胸腔积液1(4.5)4(9.3)2.154(0.226-20.529)0.655纵膈病变1(4.5)2(4.7)1.024(0.088-11.959)1.000血管侵袭形式7(31.8)19(44.2)1.696(0.576-4.9

10、97)0.335气道侵袭形式12(54.5)17(39.5)0.545(0.193-1.539)0.249注：除特殊注明外，数据是患者的例数和百分率(%)oa经面罩.无创正压通气3d,并且每天带机时间IOh0b包括有或无晕轮征的大结节，梗塞状结节。表2.患者3个月死亡的多因素分析变量偏回来系数偏回来系数标准误Wa1.dP值OR值基础病差-3.3670.92413.2670.0000.034运用有创机械通气0.8940.4194.5410.0332.444参考文献1.Russo,Fa1.coneM,Vena,eta1.Invasivepu1monaryaspergiUosisinnon-neut

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