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Clinical Analysis of Elderly Patients with Chronic Obstructive Pulmonary Disease with Nosocomial Pulmonary Fungal Infection

【摘要】 目的 探讨老年慢性阻塞性肺疾病(COPD)患者院内肺部真菌感染的可能易患因素、感染时间、临床特征、感染常见真菌与预后。 方法 回顾性分析36例65岁以上COPD 院内肺部真菌感染患者与同期40例65岁以上COPD院内肺部非真菌感染患者的临床资料。 结果 老年COPD患者院内肺部真菌感染的可能易患因素与长期使用广谱抗生素、糖皮质激素,低蛋白血症、粒细胞减少相关;吸烟时间较长及每年住院次数增多也是老年COPD患者发生院内肺部真菌感染的可能易感因素;约1/3患者肺部真菌发生在入院1~2周,临床特征无特异性;病原菌主要为白色念珠菌(8055%),胸部X线表现以支气管肺炎及团块影改变为主,预后较差。 结论 老年COPD患者若长期使用广谱抗生素和(或)糖皮质激素,有低蛋白血症或粒细胞减少,可能会并发院内肺部真菌感染,预后较差,长期吸烟及多次住院患者也应提高警惕,重视可能易患因素并尽早采取预防与治疗措施,减少死亡的发生。【Abstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.

抗结核药致药物性肝损害72例分析

肺淋巴管肌瘤病一例

临床资料 患者女性, 48 岁。因“进行性呼吸困难8年, 反复发生气胸6 年, 复发加重伴胸痛1 d”入院。患者入院前8 年轻体力劳动时感呼吸困难, 无明显其他伴随症状,休息后消失, 未引起重视。6 年前发生右侧气胸, 住我院给予胸腔闭式引流治疗, 气胸消失。之后患者感呼吸困难且进行性加重, 反复发生左侧或右侧气胸3 次, 均住院治疗好转。生活基本能自理。1 d 前患者呼吸困难加重伴左侧胸痛入院。偶咳嗽无咯痰, 无发热、咯血、浮肿等, 胸部DR 片检查发现左侧气胸, 肺压缩约50% , 双肺纹理增多、紊乱, 呈网格状改变。‥‥‥

ORMDL3 rs72l6389 Polymorphism and the Susceptibility to Asthma in Chinese Population: A Meta-analysis

ObjectiveTo systematically review the association between ORMDL3 gene rs7216389 polymorphism and the susceptibility to asthma among Chinese population. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CBM, CNKI, VIP and WanFang Data were systemically searched to collect casecontrol studies published to August 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated methodological quality of included studies. Meta-analysis was then performed using RevMan 5.2 software. Stata 11.0 software were used for publication bias evaluation. ResultsA total of 7 case-control studies were included, which involved 1 711 cases and 1 763 controls. The results of meta-analysis showed that, ORMDL3 gene rs7216389 polymorphism was associated with the susceptibility to asthma among Chinese population (OR=0.71, 95%CI 0.62 to 0.81, P<0.000 01). In the subgroup analysis by age, ORMDL3 gene rs7216389 polymorphism was associated with the susceptibility to adult asthma (OR=0.71, 95%CI 0.61 to 0.83, P<0.000 1) and children asthma (OR=0.69, 95%CI 0.52 to 0.90, P=0.006). ConclusionORMDL3 gene rs7216389 polymorphism is a risk factor of adult and children asthma among Chinese population.