Clinical Analysis Of Chronic Obstructive Pulmonary Disease Complicated With Pulmonary Mycosis

Chronic obstructive pulmonary disease(COPD)is a common disease in the respiratory system,with a high incidence and progressive aggravation.With the progressive decline of pulmonary function and the gradual decline of exercise tolerance in patients with progressive disease,the quality of life of the patients is seriously affected.Chronic obstructive pulmonary disease is prone to recurrent attacks,long-term use of broad-spectrum antibiotics and hormones,the probability of pulmonary fungal infection is high,and pulmonary fungal infection is one of the main causes of exacerbation and death in patients with chronic obstructive pulmonary disease,Therefore,analyzing the clinical characteristics of chronic obstructive pulmonary disease with pulmonary mycosis and its related high risk factors can not only guide the clinical treatment,but also prevent the occurrence of fungal infection.Because the clinical manifestations of chronic obstructive pulmonary disease complicated with pulmonary mycosis and simple chronic obstructive pulmonary disease are not specific,it is easy to miss diagnosis in clinic,which affects the treatment and prognosis of patients.Therefore,early identification of high risk factors and early diagnosis of chronic obstructive pulmonary disease associated with pulmonary mycosis is very important,but the sensitivity and specificity of traditional fungal infection detection and imaging methods are not high,in order to improve the positive rate of early diagnosis.In recent years,as a safe,rapid and non-invasive method for the detection of fungal infection,fungal antigen detection,especially serum-1-3-β-D-glucan test,has been widely used in clinical practice.It has become one of the diagnostic bases for pulmonary mycosis.Because of the influence factors of G test results,its clinical application value still needs to be further studied.ObjectiveThis study retrospectively analyzed the clinical characteristics and related risk factors of chronic obstructive pulmonary disease(COPD)complicated with pulmonary mycosis in order to provide reference for clinical treatment and prevention.Objective:to evaluate the clinical diagnostic value of 1,3-β-D-glucan test in chronic obstructive pulmonary disease(COPD)complicated with pulmonary mycosis.MethodsFrom February of 2016 to February of 2018,a total of 319 patients with chronic obstructive pulmonary disease admitted in the first affiliated Hospital of Zhengzhou University were collected,including 36 patients with pulmonary mycosis and 283patients with chronic obstructive pulmonary disease without pulmonary mycosis.The clinical characteristics and risk factors of the patients were collected and recorded.Comparison of the difference between groups by usingχ~2 test and t test;Multivariate Logistic regression analysis of risk factors,the diagnostic value of 1,3-β-D-glucan test by operating curve test.Results1.Thirty-nine strains of fungi were isolated from sputum,alveolar lavage fluid,lung tissue culture and pathology in patients with COPD complicated with pulmonary mycosis.of which 19 strains were Candida albicans(48.7%)and 9 strains were Aspergillus.2.The clinical symptoms and signs of COPD complicated with pulmonary mycosis patients were fever,cough,sputum,chest distress,respiratory tone thickeni-ng,dry and wet rales etc.There was no obvious specificity in imaging findings;3.The results of univariate analysis showed that age,sex,smoking history,hypertension,chronic heart failure,cerebrovascular disease and atrial fibrillation had no significant difference(P>0.05).There were two kinds of antimicrobial agents:hypoproteinemia,diabetes mellitus,respiratory failure,mechanical ventilation and pulmonary function gradeⅣ,all P<0.05,the difference was statistically significant.The multivariate Logistic regression analysis showed that the long-term use of glucocorticoid and the use more than 2 species of antimicrobial agents and diabetes may be risk factors of COPD complicated with pulmonary mycosis(P<0.05).Univariate analysis of the two groups showed that long-term use of glucocorticoid,use of antimicrobial agents≥2,hypoproteinemia,diabetes,respirator-y failure,mechanical ventilation,pulmonary functionⅣfactor ratio.Multivariate Logistic regression analysis showed that the long-term use of glucocorticoid,the use of antimicrobial agents≥2,diabetes,the difference was statistically significant.4.The level of 1,3-β-D-glucan in patients with chronic obstructive pulmonary disease complicated with pulmonary mycosis was significantly higher than that in patients with chronic obstructive pulmonary disease without pulmonary mycosis(P<0.05).The area under the ROC curve of the patients with high diagnostic value was0.855,when the cut-off value of serum 1,3-β-D-glucanlevel was set at 88.65pg/ml,the sensitivity,specificity,positive predictive value,and negative predictive value for diagnosis chronic obstructive pulmonary disease complicated with pulmonary mycosis were 69.4%,92.9%,69.4%,93.3%.Conclusions1.The major risk factors for chronic obstructive pulmonary disease complicated with pulmonary mycosis were diabetes mellitus,long-term glucocorticoids and the use of antimicrobial agents≥2.2.The clinical symptoms and signs of COPD complicated with pulmonary mycosis were not specific.3.The G test is of great value in the diagnosis of chronic obstructive pulmonary disease with pulmonary mycosis.G test has important clinical value in the diagnosis of chronic obstructive pulmonary disease complicated with pulmonary mycosis,but G test positive can not diagnose fungal infection and negative G test can not completely exclude fungal infection.It also needs to be combined with other checks and comprehensive judgment.