天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (7): 736-740.doi: 10.11958/20251154

• 临床研究 • 上一篇    下一篇

重症乙型流感病毒性肺炎合并侵袭性肺曲霉菌病的影响因素分析

赵志刚(), 刘辉, 刘红梅△()   

  1. 河南省人民医院呼吸与危重症医学科（邮编450000）
  • 收稿日期:2025-03-27 修回日期:2025-04-18 出版日期:2025-07-15 发布日期:2025-07-21
  • 通讯作者: △E-mail：laohu200381@163.com
  • 作者简介:赵志刚（1988），男，主治医师，主要从事呼吸危重症方面研究。E-mail：zhaozg2008@126.com
  • 基金资助:
    河南省医学科技攻关项目(LHGJ20230079)

Analysis of influencing factors of severe influenza B virus pneumonia complicated with invasive pulmonary aspergillosis

ZHAO Zhigang(), LIU Hui, LIU Hongmei△()   

  1. Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450000, China
  • Received:2025-03-27 Revised:2025-04-18 Published:2025-07-15 Online:2025-07-21
  • Contact: △E-mail：laohu200381@163.com

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摘要：

目的 探讨重症乙型流感病毒性肺炎合并侵袭性肺曲霉菌病的临床特点及危险因素。方法 收集重症乙型流感病毒性肺炎患者46例，根据是否合并侵袭性肺曲霉菌感染分为合并肺曲霉菌病组（合并组）17例和对照组（29例），比较2组患者的临床表现、实验室指标、胸部CT影像学表现、气管镜下表现、肺泡灌洗液（BALF）培养及宏基因组二代测序结果；治疗情况及最终治疗结局。单因素和多因素Logistic回归分析重症乙型流感病毒性肺炎合并侵袭性肺曲霉菌病的危险因素。结果 经治疗后6例（35.30%）患者死亡，均为合并组。2组患者中呼吸困难、咳嗽、咳痰、胸痛症状较重，同时乏力、发热、肌肉酸痛等全身症状也较为明显。2组临床症状、合并细菌感染和使用激素情况差异无统计学意义。与对照组比较，合并组白细胞计数、中性粒细胞计数、血半乳甘露聚糖（GM）试验以及BALF GM试验水平，影像学表现为结节和斑片影的患者占比、气管镜下出现伪膜表现患者占比更高（P<0.05）。单因素Logistic回归分析结果显示，白细胞计数、BALF GM、肺部影像中结节影和斑片影、气管镜下伪膜表现是重症乙型流感病毒性肺炎合并侵袭性肺曲霉菌病的影响因素（P<0.05）。多因素Logistic回归分析结果显示，肺泡灌洗液GM≥1和气管镜下伪膜表现为重症乙型流感病毒性肺炎合并侵袭性肺曲霉菌病的独立危险因素（P<0.05）。结论 重症乙型流感病毒性肺炎患者肺泡灌洗液GM试验水平≥1且气管镜下见伪膜表现时，需高度警惕合并侵袭性肺曲霉菌感染可能。

关键词: 乙型流感, 肺炎, 病毒性, 侵袭性肺曲霉菌病, 支气管镜, 半乳甘露聚糖试验

Abstract:

Objective To investigate the clinical characteristics and risk factors of severe influenza B viral pneumonia complicated with invasive pulmonary aspergillosis. Methods Forty-six patients with severe influenza B virus pneumonia were collected and divided into the invasive pulmonary aspergillosis (IPA) group (17 cases) and the control group (29 cases) based on whether they were complicated with IPA. The clinical manifestations, laboratory indicators, chest CT imaging findings, bronchoscopic manifestations, broncho alveolar lavage fluid (BALF) culture and metagenomic next-generation sequencing results were compared between the two group. Treatment conditions and final treatment outcomes were also compared between the two groups. Univariate and multivariate Logistic regression analyses were conducted to explore risk factors of severe influenza B virus pneumonia complicated with IPA. Results After treatment, a total of 6 patients died (35.30%), all of whom were in the invasive pulmonary aspergillosis group. In both groups, the symptoms of dyspnea, cough, expectoration and chest pain were more severe, and systemic symptoms such as fatigue, fever and muscle pain were also quite obvious. There were no significant differences in clinical symptoms, combined bacterial infection and hormone use between the two groups. Compared with the control group, white blood cell count, neutrophil count, blood GM test and BALF GM test were higher in the combined group. The proportion of patients with nodules and patchy shadows on imaging and the proportion of patients showing pseudomembrane manifestations under bronchoscopy were higher (P<0.05). Univariate Logistic regression analysis showed that white blood cell count, GM in BALF, nodules and patchy shadows in lung imaging and pseudomembrane manifestations under bronchoscopy were influencing factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Multivariate Logistic regression analysis showed that GM ≥ 1 in BALF and pseudomembrane manifestations under bronchoscopy were risk factors for severe influenza B virus pneumonia combined with invasive pulmonary aspergillosis (P<0.05). Conclusion When GM test level of BALF in patients with severe influenza B virus pneumonia is ≥1 and pseudomembrane manifestations are seen under bronchoscopy, the possibility of combined invasive pulmonary aspergillus infection should be highly vigilant.

Key words: influenza B virus, pneumonia, viralviral, invasive pulmonary aspergillosis, bronchoscopes, galactomannan test

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