Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors
Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors
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DOI：
10.1111/jdi.13183
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发表时间：
2019-12-20
影响因子：
3.2
通讯作者：
Gong, Yingying
中科院分区：
文献类型：
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作者：
Lao, Minxi;Li, Chen;Gong, Yingying
目的：对2型糖尿病合并侵袭性真菌病的临床特点及相关因素进行回顾性研究。材料与方法记录人口学和临床资料。对相关因素进行Logistic回归分析。结果确诊为侵袭性真菌病的2型糖尿病患者120例，患病率为0.4%。酵母菌感染最常见(56/120，46.7%)，包括念珠菌病(31/56，55.4%)和隐球菌病(25/56，44.6%)。念珠菌病主要累及尿路(12/31，38.7%)。超过一半的隐球菌病(16/25，64.0%)表现为肺炎。霉菌感染占40.8%，以肺部感染为主(34/49，69.4%)。共有15例(12.5%)患者合并真菌感染。主要致病菌为白色念珠菌(24/111，21.6%)、新生隐球菌(19/111，17.1%)和烟曲霉菌(14/111，12.6%)。合并感染58例(48.3%)，主要表现为革兰氏阴性杆菌肺炎。侵袭性真菌病住院死亡率为23.3%(28/120)。死亡患者糖化血红蛋白水平高于存活患者(8.8+/-2.5vs7.7+/-2.1%，P=0.02)。贫血(调整后优势比3.5，95%可信区间1.95~6.27，P&0.001)、低蛋白血症(调整后优势比5.42，95%可信区间3.14~9.36，P=0.001)和血肌酐升高(调整后优势比2.0 8，95%可信区间1.0 7~4.0 4，P=0.0 3)与2型糖尿病侵袭性真菌病有关。结论侵袭性真菌病是威胁2型糖尿病患者生命的并发症。白色念珠菌、新生念珠菌和烟曲霉菌是主要的致病菌。长期的高血糖会导致不良的结局。纠正贫血和低蛋白血症可改善预后。
Aims/Introduction A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria. The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 +/- 2.5 vs 7.7 +/- 2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.