侵袭性肺曲霉病患者预后因素研究.docVIP

侵袭性肺曲霉病患者预后因素研究【摘要】目的 研究影响侵袭性肺曲霉病（IPA）患者的预后因素。方法 回顾性分析四川大学华西医院在2005年1月至2011年6月间诊断的65例成人IPA患者的资料，并且诊断符合2008 年欧洲癌症研究治疗组织/真菌病研究组（EORTC/MSG）的定义标准。胸部CT特征由两位从事胸部CT的高年资医生采用盲法解读患者的初次胸部CT表现，并对异常影像进行分类。根据IPA诊断后3个月病情转归将患者分为存活组（ n =43）和病死组（ n =22）。采用成组 t 检验、χ2检验或Fishers精确检验行两组间变量的差异比较，多因素分析用Logistic回归方法。结果 65例患者中，确诊23例（35%），临床诊断42例（65%）。单因素分析发现3个月存活组和病死组之间肺外感染、基础疾病控制差和机械通气方式差异具有统计学意义（均 P 0.05）。Logistic多因素回归分析发现仅基础疾病控制差影响3个月预后（P =0.001， OR =0.024，95% CI ：0.003～0.223， B =—3.714， SE =1.129， Wald =10.821）。结论 基础疾病控制状况是判断IPA患者3个月生存的独立危险因素，但本研究中CT特征不提示预后。 【关键词】侵袭性肺曲霉病；真菌性肺病；免疫抑制；CT扫描；预后因素 Analysis of factors implicated in the outcomes of patients with invasive pulmonary aspergillosis XU Si—cheng*， DONG Xu—nan， DENG Li—jing， GUO Xin—hong， SANG Xiao—hong， QIU Li—hua， REN Bing—xiu. *Intensive Care Unit， The First Affiliated Hospital， Xinjiang Medical University，Urumqi 830054， China. Corresponding author： XU Si—cheng ， Email： xu_sicheng@ 【Abstract】Objective To investigate the factors implicated in the outcomes of patients with invasive pulmonary aspergillosis （IPA）. Methods During a 5—year period， 65 patients with IPA met the criteria set by the European Organization for Research and Treatment of Cancer/Mycoses Study Group （EORTC/MSG） in 2008 were retrospectively evaluated. The initial CT findings of eligible patients were reviewed by two senior radiologists who specialized in chest radiology. Patients were divided into the survivor （ n =43） and non—survivor （ n =22） groups according to their survival as long as 3 months after the diagnosis of IPA was made. An initial univariate analysis was used to screen variables that were related to prognosis， followed by a multivariate logistic regression analysis to examine these variables.Results Of the 65 IPA patients analyzed， 23 （35%） had a proven diagnosis and 42 （65%） were probable ones. The univariate analysis showed that the rates of extra—pulmonary infection， uncontrolled underlying diseases and invasive mechanical ventilation were