Analysis of pathogen characteristics and risk elements of lung infection in sufferers with chronic cardiac failure complicated with chronic renal disease
慢性心力衰竭合并慢性肾脏病患者肺部感染病原学特点及高危因素分析

摘要

目的 探讨慢性心力衰竭合并慢性肾脏病肺部感染病原学特点及高危因素。方法 回顾性选取2020年1月-2024年05月云南省第三人民医院收治的250例慢性心力衰竭合并慢性肾脏病患者作为研究对象,根据患者是否发生肺部感染分为并发肺部感染组(n=121)和未并发肺部感染组(n=129)。收集慢性心力衰竭合并慢性肾脏病患者的临床资料,性别、年龄、吸烟史、有无侵入性操作（血液或腹膜透析、深静脉置管等，不包括外周浅静脉穿刺）、心率、心律、心功能分级、射血分数（EF）、血红蛋白（HB）、超敏c反应蛋白（CRP）、血清白蛋白（ALB）等。统计发生肺部感染现况及病原学特点,采用单因素分析、多因素 Logistic回归分析统计学方法来分析慢性心力衰竭合并慢性肾脏病患者发生肺部感染的独立高危因素；绘制受试者工作特征（ROC）曲线来分析上述独立危险因素对慢性心力衰竭合并慢性肾脏病患者发生肺部感染的预测价值。结果 在250例慢性心力衰竭合并慢性肾脏病患者中，121例（48.4%）发生了肺部感染;共培养出25株病原菌,其中培养出革兰阳性菌（G+）10株，感染率为40%，主要包括肺炎链球菌、金黄色葡萄球菌、表皮葡萄球菌等菌株；培养出革兰阴性菌（G-）13株，感染率为52%，主要包括鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟杆菌、嗜麦芽窄食单胞菌；培养出真菌2株，感染率为8%，主要为白假丝酵母菌、曲霉菌;有吸烟史、心功能分级较差（Ⅲ-Ⅳ级）、有侵入性操作、高CRP水平、低血清白蛋白水平均为慢性心力衰竭合并慢性肾脏病发生肺部感染的独立危险因素（P＜0.05）；CRP水平对慢性心力衰竭合并慢性肾脏病发生肺部感染具有较好的预测价值(AUC=0.888)，心功能分级、侵入性操作和吸烟等指标也有一定的判别力。结论 慢性心力衰竭合并慢性肾脏病患者肺部感染率较高，除了常见的肺炎链球菌感染外，革兰阴性菌如肺炎克雷伯菌、鲍曼不动杆菌及真菌的感染率高，临床可根据此类患者肺部感染病原学特点针对性使用抗生素治疗，同时对于其危险因素给予患者相应干预措施。

Abstract

Objective Probe the pathogen characteristics and high-risk elements of lung infection in chronic cardiac failure complicated with chronic renal disease.
Methods Retrospectively selected 250 cases of patients with chronic cardiac failure complicated by chronic renal disease treated from January 2020 to May 2024 at the Third People's Hospital of Yunnan Province as the research objects. Sufferers were divided into two groups based on whether they developed pulmonary infection: the pulmonary infection group (n=121) and the non-lung infection group (n=129). Clinical data of sufferers with chronic cardiac failure and chronic renal disease were collected, including gender, age, smoking history, history of invasive procedures (blood or peritoneal dialysis, central venous catheterization, etc., excluding peripheral superficial venipuncture), heart rate, cardiac rhythm, cardiac function classification, hemoglobin (HB), high - sensitivity C - reactive protein (CRP), ventricular ejection fraction (EF), and serum albumin (ALB). The current status and etiological characteristics of lung infections were statistically analyzed. The methods used were univariate analysis and multivariate logistic regression analysis, to dissect the independent risk factors for lung infection in sufferers with chronic cardiac failure and chronic renal disease. The method employed was to draw the Receiver Operating Characteristic (ROC) curves to analyze the predictive value of relevant influencing elements on lung infections in sufferers with chronic cardiac failure and chronic renal disease.
Results Out of 250 cases of sufferers with chronic cardiac failure complicated by chronic renal disease, 121 had concurrent pulmonary infections, with an attack rate of 48.4%. A total of 25 bacterial strains were cultured, among them, 10 strains were Gram-positive bacteria, accounting for 40%, mainly Staphylococcus aureus, Streptococcus pneumoniae, Staphylococcus epidermidis; 13 of them were Gram-negative bacteria, accounting for 52%, mainly Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, and Stenotrophomonas maltophilia; and 2 fungal strains, accounting for 8%, mainly Candida albicans and Aspergillus species. A history of smoking, poor cardiac function classification, invasive procedures, high levels of C-reactive protein (CRP), and low contents of serum albumin are all stand-alone risk factors for lung infection in sufferers with chronic cardiac failure and chronic renal disease (P<0.05). The level of CRP has high predictive worth for pulmonary infection in sufferers with chronic cardiac failure and chronic renal disease (AUC=0.888), and indicators such as heart function grading, invasive procedures, and smoking also have certain discriminative power.
Conclusion   Patients with chronic cardiac failure complicated by chronic renal disease have a high rate of pulmonary infections. In addition to the common Streptococcus pneumoniae infection, the infection rates of Gram-negative bacteria such as Klebsiella pneumoniae, Acinetobacter baumannii and fungi are high. Clinically, targeted treatments and intervention measures can be provided to these patients based on the risk factors for pulmonary infection.