老年慢性阻塞性肺疾病合并2型糖尿病患者院内肺部感染发生风险及危险因素分析

Analysis of risk and risk factors of nosocomial pulmonary infection in elderly patients with COPD complicated with T2DM

中文关键词: 老年  2型糖尿病  慢性阻塞性肺疾病  肺部感染  炎症  糖皮质激素  危险因素

英文关键词: elderly  type 2 diabetes mellitus  chronic obstructive pulmonary disease  pulmonary infection  inflamma-tion  glucocorticoid  risk factor

中文摘要:

      目的 探究老年慢性阻塞性肺疾病(COPD)合并2型糖尿病(T2DM)患者院内肺部感染发生风险及危险因素.方法 回顾性选取2021年1月1日—2024年12月31日在滁州市第一人民医院住院治疗的170例老年COPD合并T2DM患者的临床资料,根据患者住院期间是否发生肺部感染划分为感染组(n=56)和未感染组(n=114).比较2组患者临床基础特征、住院治疗特征、血糖控制情况、炎症水平特征.通过Logistic回归分析筛选老年COPD合并T2DM患者院内肺部感染的影响因素.结果 入组患者中56(32.9％)例发生院内肺部感染,共培养出病原菌68株.感染组患者年龄、合并吸烟史占比、机械通气应用占比、高流量吸氧占比、接受支气管镜检查及治疗占比、糖皮质激素使用剂量、支气管扩张剂使用频率、入院时糖化血红蛋白、白细胞介素6(IL-6)水平均高于未感染组,COPD病程、吸烟年限、抗生素使用时间均长于未感染组,差异均具有统计学意义(P＜0.05).多因素Logistic回归分析表明年龄、机械通气应用占比、抗生素使用时长、糖皮质激素使用剂量、糖化血红蛋白水平、IL-6水平较高均是老年COPD合并T2DM患者发生院内肺部感染的重要影响因素(P＜0.05).结论 年龄、机械通气、长期应用抗生素及糖皮质激素、糖化血红蛋白水平、IL-6水平较高均是老年COPD合并T2DM患者院内肺部感染的独立危险因素,临床上应采取针对性的预防和治疗措施,以降低患者院内肺部感染风险.

英文摘要:

      Objective To investigate the risk of nosocomial pulmonary infection and risk factors in elderly patients with chronic obstructive pulmonary disease(COPD)complicated by type 2 diabetes mellitus(T2DM).Methods The clinical data of 170 elderly patients with COPD complicated with T2DM who were hospitalized in First People's Hospital of Chuzhou City from January 1,2021 to December 31,2024 were retrospectively selected.The patients were divided into infection group(n=56)and non-infection group(n=114)according to whether pulmonary infection occurred during hospitalization.The clinical basic characteristics,inpatient treatment characteristics,blood glucose control conditions and inflammatory characteristics were compared between the two groups.Logistic regression analysis was used to screen the influencing factors for nosocomial pulmo-nary infection in elderly COPD patients with T2DM.Results Among the enrolled patients,56 cases(32.9％)developed nos-ocomial pulmonary infection,and a total of 68 strains of pathogenic bacteria were cultured.The age,proportion of patients with smoking history,proportion of mechanical ventilation application,proportion of high-flow oxygen inhalation,proportion of bronchoscopy examination and treatment,dosage of glucocorticoids,frequency of bronchodilator use,glycosylated hemoglo-bin(HbA1c)level at admission,and interleukin-6(IL-6)level of the infected group were all higher than those of the non-in-fected group,and the duration of COPD,smoking years,and antibiotic use time were all longer than those of the non-infected group.The differences were statistically significant(P＜0.05).Multivariate logistic regression analysis showed that age,pro-portion of mechanical ventilation application,duration of antibiotic use,dosage of glucocorticoids,high levels of HbA1c and IL-6 were all important influencing factors for nosocomial pulmonary infections in elderly COPD patients with T2DM(all P＜0.05).Conclusion Age,mechanical ventilation,long-term use of antibiotics and glucocorticoids,and high levels of HbA1c and IL-6 are all independent risk factors for nosocomial pulmonary infection in elderly COPD patients with T2DM.Clinically,targeted preventive and therapeutic measures should be taken to reduce the risk of nosocomial pulmonary infection in patients.