念珠菌血症的危险因素和预后分析

目的了解念珠菌血症的临床特点、分布及预后危险因素。方法回顾性调查2012年1月至2014年5月浙江大学医学院附属第一医院所有血培养念珠菌阳性的患者资料,分析其临床特征、治疗和预后等,采用χ2检验或Fisher精确概率法进行预后单因素分析,采用多元Logistic回归进行预后多因素分析。结果 97例念珠菌血症患者入选,其中男性64例,女性33例,平均年龄（59.6±16.8）岁。包括白色念珠菌51例（52.6%）,非白色念珠菌46例（47.4%）,非白色念珠菌中热带念珠菌17例（17.5%）、近平滑念珠菌12例（12.4%）、光滑念珠菌7例（7.2%）、无名念珠菌4例（4.1%）、其他念珠菌6例（6.2%）。念珠菌培养阳性后30 d内死亡37例,30 d病死率为38.1%。Logistic多因素回归分析显示：年龄（OR=1.104,95%CI：1.041~1.170,P=0.001）、血液系统肿瘤（OR=63.256,95%CI：2.898~1380.833,P=0.008）、APACHEⅡ评分（OR=1.176,95%CI：1.053~1.313,P=0.004）、感染性休克（OR=12.032,95%CI：2.389~60.587,P=0.003）及合并细菌性血流感染（OR=26.016,95%CI：4.002~169.127,P=0.001）是其死亡的独立危险因素;而拔除或更换深静脉置管（OR=0.118,95%CI：0.025~0.559,P=0.007）是念珠菌血症死亡的独立保护性因素。结论念珠菌血症患者分布科室范围广、基础疾病重、侵入性操作多。年龄、高APACHEⅡ评分、感染性休克及合并细菌血流感染是影响念珠菌血症死亡的独立危险因素,拔除或更换深静脉置管是念珠菌血症死亡的独立保护性因素。

Analysis of risk factors and prognosis of patients with candidemia

Objective To understand the clinical distribution and characteristics of candidemia and analyze the risk factors and prognosis. Methods A retrospective study was conducted on patients with candidemia in our hosptial between January 2012 and May 2014. The clinical characteristics,treatment and prognosis were analyzed retrospectively. The prognostic factors were analyzed by chi square test or Fisher exact probability test. The multivariate Logistic regression analysis was used to determine the prognostic risk factors of candidemia. Results A total of 97 inpatients were included. There were 64 males and 33 females with a mean age of（ 59. 6 ± 16. 8） years. 51（ 52. 6%） cases were identified as Candida albicans and 46（ 47. 4%） as non-Candida albicans. Non-Candida albicans species included Candida tropicalis（ 17 /97,17. 5%）,Candida parapsilosis（ 12 /97,12. 4%）,Candida glabrata（ 7 /97,7. 2%）,Candida famata（ 4 /97,4. 1%） and other Candida spp.（ 6 /97,6. 2%）. Thirty-seven cases died within thirty days from the onset of candidemia; overall thirty-day mortality was 38. 1%. Multivariate Logistic regression analysis indicated that age（ OR = 1. 104,95% CI： 1. 041- 1. 170,P = 0. 001）,hematologic malignancy（ OR = 63. 256,95% CI： 2. 898-1380. 833,P = 0. 008）,acute physiology and chronic health evaluation II（ APACHEⅡ） score（ OR = 1. 176,95% CI： 1. 053- 1. 313,P = 0. 004）,septic shock（ OR = 12. 032,95% CI： 2. 389-60. 587,P = 0. 003） and concurrent bacteremia（ OR = 5. 541,95% CI： 1. 576- 19. 487,P =0. 008） were the independent risk factors of candidemia-related mortality,while removal or replacement of central venous catheter（ OR = 0. 118,95% CI： 0. 025-0. 559,P = 0. 007） was a protective factor. Conclusion Candidemia are widely distributed with serious underlying disease and much invasive procedures. Old age,higher APACHEⅡ score,septic shock and concurrent bacteremia are independent risk factors attributing to candidemia-related mortality,while removal or r