临床误诊误治2024，Vol.37Issue(13)：45-50,6.DOI:10.3969/j.issn.1002-3429.2024.13.010
老年2型糖尿病合并社区获得性肺炎的病原学特点及死亡危险因素分析
Etiological Characteristics and Risk Factors of Death in Elderly Patients with Type 2 Diabetes Mellitus Complicated with Community-acquired Pneumonia
摘要
Abstract
Objective To investigate the etiological characteristics and risk factors of death in elderly patients with type 2 diabetes mellitus(T2DM)complicated with community-acquired pneumonia(CAP).Methods The case data of 190 elderly patients with T2DM combined with CAP admitted from April 2021 to April 2023 were retrospectively analyzed and di-vided into death group and survival group according to the prognosis in hospital.The pathogenic bacteria distribution character-istics and clinical data of the two groups were compared,and the risk factors of death in elderly patients with T2DM combined with CAP were analyzed by multivariate Logistic regression analysis.Results Among 190 elderly patients with T2DM com-bined with CAP,159(83.68%)patients survived in hospital,and there were 31 deaths(16.32%).The pathogenic bacteri-a detected included164 gram-negative bacteria,94 gram-positive bacteria and9 fungi,accounting for61.42%,35.21%and 3.37%,respectively.Additionally,53 strains of Acinetobacter baumannii,46 strains of Klebsiella pneumoniae,46 strains of Staphylococcus aureus,32 strains of Streptococcus pneumoniae and 24 strains of Pseudomonas aeruginosa were detected,ac-counting for 19.85%,17.23%,17.23%,11.99%and 8.99%of the total pathogens,respectively.The infection rates of Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae,and mixed bacteria in death group were higher than those in survival group(P＜0.05).Mechanical ventilation,chronic kidney disease,pneumonia severity index(PSI)score≥130 points,sepsis,hemoglobin A1c(HbA1c)＞8.0%,white blood cell count(WBC)＞10×109/L,as well as elevated blood lactic acid,serum creatinine(Scr),C-reactive protein(CRP),and decreased CD4+/CD8+and CD4+,were inde-pendent risk factors for death in elderly patients with T2DM and CAP(P＜0.05,P＜0.01).Conclusion In elderly pa-tients with T2DM combined with CAP,the pathogenic bacteria are widely distributed,mainly gram-negative bacteria.Mechan-ical ventilation,chronic kidney disease,PSI score≥130,sepsis,HbA1c＞8.0%,WBC＞10×109/L,as well as elevated serum lactate,Scr,CRP,and decreased CD4+/CD8+and CD4+were all independent risk factors for death in elderly pa-tients with T2DM combined with CAP.关键词
糖尿病,2型/社区获得性肺炎/老年人/革兰阴性菌/革兰阳性菌/真菌/预后/危险因素Key words
Diabetes mellitus,type 2/Community-acquired pneumonia/Elderly/Gram-negative bacteria/Gram-positive bacteria/Fungi/Prognosis/Risk factors分类
临床医学引用本文复制引用
许圣慧,王坤芳,谢轩,于凯娜,闫丽娟,吕侯强..老年2型糖尿病合并社区获得性肺炎的病原学特点及死亡危险因素分析[J].临床误诊误治,2024,37(13):45-50,6.基金项目
河北省医学科学研究课题计划项目(20231631) （20231631）
