ABSTRACT
Objective To study the risk factors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) induced by community-acquired Pseudomonas aeruginosa(PA) infection which provides the basis for early clinical intervention in high-risk patients.Methods Retrospective analysis of clinical data from 236 patients with acute exacerbation of COPD was conducted in Department of Respiratory Medicine of our hospital from January 2015 to December 2015.The patients were divided into PA group(n=44)and the non-PA group(n=192)according to respiratory tract pathogen infection.The univariate analysis and multivariate logistic regression analysis were performed between the two groups to analyze risk factors for AECOPD induced by PA infection.Results Univariate analysis showed that hypoalbuminemia,AECOPD-induced hospitalization in the recent one year,application of broad spectrum antibiotic within recent 90 days,intermittent use of systemic corticosteroids within recent 90 days,lung function grading of GOLD3/4 level in COPD,acute exacerbation frequency＞ 1 time in last year,the BODE index,walking distance during six minutes,mMRC grading,and CAT scores were significantly correlated with occurrence of community acquired PA-induced AECOPD(all P＜ 0.05).Logistic regression analysis showed that higher BODE index,AECOPD-induced hospitalization in the last year,the use of broad spectrum antibiotic within 90 days and hypoalbuminemia were independent risk factors for community acquired PA induced-AECOPD(OR =14.573、18.958、4.170、5.112,all P＜0.05).Conclusions We suggest that the COPD patients having a higher BODE index scores should be clinically intervened early to reduce the occurrence of AECOPD-induced hospitalization,should receive active etiology examination,and should receive therapies for community-acquired Pseudomonas aeruginosa (PA)infection with specific narrowspectrum antibiotics according to the drug susceptibility and multiple comprehensive measurements,and for correcting hypoalbuminemia.
ABSTRACT
Objective To analyze the clinical features of nonimmunocompromised patients with allergic bronchopulmonary aspergillosis (ABPA).Methods The clinical data of 11 nonimmunocompromised patients diagnosed as ABPA from June 2010 to December 2015 in Zhejiang Jinhua People's Hospital were retrospectively analyzed.SPSS 18.0 was used for analysis.Results Among 11 patients with ABPA, Five were males and 6 were females, with an average age of (49.3 ±11.0) years.All patients had cough, expectoration and wheezing;cough and tan sputum in 4 cases, bloody sputum in 3 cases, fever in 2 cases and chest pain in 2 cases.In auscultation dry rales were heard in all patients , and limited wet rales were heard in 3 cases.The peripheral blood leukocyte counts were elevated in 5 patients [11.7(10.3-13.5) × 109/L)] and the eosinophils counts were increased in 9 patients [1.79(0.09-7.63) ×109/L].The total IgE was elevated to 3640(1329-9430) IU/mL.Skin prick test was positive ( grade 3 to 5) in 10 cases, Aspergillus fumigatus specific IgE increased to 23.6(1.75-67.30) kU/L in 6 cases, Aspergillus fumigatus specific IgG raised to 83.3(51-126) mg/L in 5 cases.Chest CT showed patchy, punctate exudation in 8 cases, central bronchiectasis in 9 cases, bronchial mucosal plug formation in 4 cases, and atelectasis in 1 case.Mediastinal lymph nodes were found in 2 cases.All 11 patients were treated with glucocorticoid hormone, and 8 patients were also received itraconazole oral solution for treatment.After treatment, the clinical symptoms were improved rapidly.Conclusion Nonimmunocompromised patients with ABPA have no specific clinical manifestations , and often are misdiagnosed as asthma , which is worth the attention of clinicians.