【摘要】 目的探讨类风湿性关节炎(RA)合并肺部真菌感染的临床特征和危险因素。方法收集2005年7月-2010年7月医院住院RA患者81例临床检查及治疗方案资料,其中合并肺部真菌感染者31例,对照组非感染者50例。结果真菌感染组男性占54.8%,平均年龄为(62.0±16.0)岁,对照组男性占32.0%,平均年龄为(51.0±17.0)岁,感染组疾病活动指数为2.9±1.2,小于对照组3.5±2.1,日均糖皮质激素剂量感染组为(22.4±12.5)mg/d,高于对照组(5.8±6.5)mg/d,CRP/白蛋白比值感染组低于对照组,使用免疫抑制剂、肿瘤坏死因子拮抗剂并不增加真菌感染概率,间质性肺炎、长期联合应用抗菌药物是继发真菌感染的危险因素;31例合并肺部真菌感染组患者中,死亡14例,死亡率45.2%。结论对男性、高龄、存在间质性肺炎的患者避免长期大量应用糖皮质激素,适时停用抗菌药物,使用肿瘤坏死因子拮抗剂应慎重选择患者,纠正营养不良,有利于患者避免感染及促进患者早日康复。更多还原

【Abstract】 OBJECTIVE To study the clinical characteristics and the risk factors of pulmonary fungal infections with rheumatoid arthritis patients.METHODS The clinical characteristics and therapy strategy of eighty one patients with rheumatoid arthritis were analyzed.Thirty one of them were fungal infections.RESULTS Old male were more likely suffer from fungal infections,accounting for 54.8% with the average age of(62.0±16.0)in infection group,and 32.0% with the average age of(51.0±17.0) in control group;DAS28 of the infection group(2.9±1.2) was lower than that of the control group(3.5±2.1);the glucocorticoid dosage of infection group(22.4±12.5)mg/d was higher than the control group(5.8±6.5)mg/d;there was no evidence indicated that DMARDS and TNF-α inhibitor were the risk factors;C-reactive protein/albumin ratio was higher in the infection group than the control group;Interstitial pneumonia and long term combination of antibacterial increased the risk of fungal infections.14 cases were dead with the mortality rate of 45.2% among 31 cases of patients combined with pulmonary infection.CONCLUSION High dosage and long term of glucocorticoid and antibacterial should be avoided for the old male RA patients with interstitial pneumonia.It should be discreet for us to decide who should accept the TNF-α Inhibitor treatment.Nutrition is important for the patient to get well.更多还原