| Chronic obstructive pulmonary disease (COPD) is a kind of disease that could be prevented and treated, and it holds a characteristics that the airflow can be restricted .But the airflow limitation was not fully reversible ,it develops progressively, in relation to the lung's abnormal inflammations reaction to the harmful gases and harmful particles .The most common cause of COPD is infection. In addition, because of the aging of population and the application of broad-spectrum antibiotics immunosuppressant's, glucocorticoid , invasive operation , the rate of the clinic secondary fungal infection in COPD has a upward tendency ,and it brings a serious threat to the patients .It takes much longer time to treat fungal infection .Antifungal drugs is not only very expensive but it has the side effects .As well many fungal has natural resistance to the antifungal drugs .So it is difficult to cure fungal infection .The key factor to cure it lies in its early diagnosis and early treatment ,however, there is no specific character in the clinical manifestations of secondary fungal infection in COPD and clinical imaging examination .Objective: It will provide a favorable basis for clinical diagnosis, treatment and prevention to understand the rate of morbidity, clinical manifestations, incidence and the related auxiliary factors in the acute stage of COPD.Materials and Methods: In this study, it selected 602 cases from February 2006 to February 2008, which had already been diagnosised of acute exacerbation of COPD secondary fungal infection in the ours Hospital. In the 602 cases ,there are 315 female cases,( 52.3%), 287 male cases(47.7%). And the youngest is only 32 years old ,the oldest is 94 , the average age ( 67.07±12.41).According to a=0.05,the difference of p<0.05 has a statistical significance .Count data adopt x2 test, using SPSS13.O to develop the correlation analysis on the software of dangerous factors, including single-factor analysis and multiple factors Logistic regression analysis.Results: In the 602 patients with the diagnosis of acute exacerbation of COPD, there are 83 cases in the secondary fungal infection; the prevalence rate was 13.79%. 38 male cases (45.8%), female 45 cases (54.2%). According toχ2 test,χ2= 0.123 <3.84, P> 0.05, the incidence of men and women showed no significant difference. However, after dividing those 83 cases into two groups by the 65-year-old limit line, andχ2 test ,x2=6.66>3.84, p<0.05, the difference was significant . Obviously, with the growth of that age, the incidence of secondary fungal infection was in upward trend. The specimen s used to diagnose the fungal infection were primarily from the specimens of the pass deep tracheal sputum ,including Candida abdicants with the total of 11 cases (13.25%);smooth Candida and Asperillus ,respectively with 4cases (4.82%);Candida tropical with 2 cases (2.40%);and others being fungal spores seen by smear test ,of which the separation of bacteria wasn't seen. In the 83 cases of fungal infections , there were 8 cases related to bacterial infection and the bacteria included Pseudomonas aerations , Staphylococcus aurous, Enterococcus faecalis,Entrerobacter cloacae, MRSA ,Klebsiella pneumoniae, Stenotrophononas maltophilia Aerononas bacteria , as well as Acinetobacter baunannii. The mortality rate of the fungal infection was 14.46%,while it for non-fungal infection group was 6.55% , by theχ2 test ,P<0.05.The differences were significant .The fungal infection group mortality was significantly higher than that of non-fungal infection . Secondary fungal infection in COPD brought no specifc clinical manifestations, mainly like fever (57 cases ,68.67%), cough (71 cases ,85.54%), expectoration( 64 cases ,77.11%), sputum being difficult to spit (43 cases ,51.81 %), dyspnea (20 cases ,24.10%), But because the above manifeststations could be due to COPD,the symptoms are easily covered by the original disease. The image change for the main performance Feiwenli increased disorder in 69 cases (83.13), higher destiny video Flake in 15 cases (18.07%)nodular shadow of four cases (4.82%), Crescent levy in two case (2.41%),ground glass-like ,changes in 5 cases(6.02%),from which nodular shadow and ideo Crescent caused by Aspergilllus infection are more specific.At the same time ,we did single analysis on the factors related to the fungal infection and found that age, length of stay, type of antibiotics and antibiotic treatment, hormone treatment, serum albumin, invasive operation are secondary fungal infection risk factors.Using the logistic regression analysis on the above risk factors .The results showed that the treatment of antibiotics and hormone are long, long time of hospitalization, and plasma albumin are below normal, clinics existing invasive fungal infections secondary to the operation of the main risk factors.Conclusion: (1)COPD with its high incidence, is a common and multiple disease,.In the acute stage-secondary fungal infection, the incidence rate was 13.79 percent, It turns to be a upward trend with the growth of age, and it has no gender differences .From the statistics Analysis, hypoproteinemia, hospital a long time, there being invasive operation, antibiotics and hormone treatment are the main risk factors;moreover fungal infection group mortality was significantly higher than that of non-fungal infection. (2) The secondary fungal infection's main clinic manifestations are fever, cough, expectoration, not being spit viscous sputum, and difficulty breathing ,but the main clinical manifestations of diseases are easily covered. The imaging examination has no specificity, and it is difficult to draw a distinction with image changes .And to some extent mthe invasive sampling operation is difficult ,so the quality of sputum specimens submitted is very important through improving the delivery then the diagnostic rate will be increased .Candida albicans is the main pathoger,while the smooth Candida albicans Candida Krusei and Candida tropical are also common .(3) Strict control of antibiotics and hormones indications and treatments, if there are contradictions between them, we should weigh the pros and cons and strength en the nutriational support to shorten the length of staying and to minimize invasive operation to e able to reduce the incidence of secondary fungal infection. |
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