Objective To investigate the correlation between interleukin(IL) -1 family, classical inflammatory markers and pulmonary function in patients with stable chronic obstructive pulmonary disease(COPD). Methods Forty-five patients with stable COPD who visited the outpatient clinic or ward of the Department of Geriatrics,Beijing Jishuitan Hospital,Capital Medical University,from July 2021 to December 2022 were selected for a prospective cross-sectional survey to collect gender,age,smoking history and smoking index,underlying disease information,and serum IL-1 family(IL-1α,IL-1β,IL-18),IL-6,IL-8,TNF-α detection and pulmonary function tests. Results Multivariate regression analysis found that IL-18 was independently correlated with forced expiratory volume in the first second(FEV1) predicted value(FEV1%),IL-18 and age were independently associated with the single-breath diffusing lung capacity of carbon monoxide(DLCO),IL-18 was independently related to the improvement rate of FEV1. Conclusion IL-18 level in stable COPD was significantly correlated with pulmonary ventilation function,pulmonary diffusion capacity and FEV1 improvement rate,which suggesting that IL-18 may play an important role in the development of the disease at this stage and can be used as the good monitoring indicators for the evaluation of stable COPD.

目的 观察老年髋部骨折患者术后1周内给予唑来膦酸(zoledronic acid,ZOL)治疗对骨代谢标志物的影响.方法 收集2015年5～12月北京积水潭医院收治的99例老年髋部骨折患者的临床资料,分为ZOL组(n=55)和对照组(n=44).于用药前、用药后2周 ～1个月、用药后1～3个月、用药后3～6个月、用药后6～9个月、用药后≥9个月6个时间点检测患者血清总Ⅰ型胶原氨基末端前肽(total procollagen typeⅠamino terminal peptide,tPINP)、碱性磷酸酶(alkaline phosphatase,ALP)、Ⅰ型胶原羧基端肽 β特殊序列(β-isomerized C-terminal telopeptides,β-CTX)、血清骨钙素(osteocalcin,OC)、25-羟基维生素D3、甲状旁腺激素及血钙、血磷水平,比较两组骨代谢标志物特点及变化差异.结果 ZOL组在用药后2周 ～1个月 β-CTX及OC均值出现下降,且用药2周后的5个检测点两指标均数皆显著低于对照组(P均<0.05);ZOL组tPINP及ALP均数在用药后2周 ～1个月出现波峰消失(P<0.05),且用药后2周 ～6个月的3个检测点两指标均数皆显著低于对照组(P<0.05),25-羟基维生素D3、甲状旁腺激素及血钙、血磷组间比较,差异无统计学意义.结论 老年髋部骨折患者术后早期输注ZOL,可出现骨吸收及骨转换水平迅速、显著而且持久的抑制;术后骨形成高峰呈"消减"表现,但对骨形成的抑制作用于6个月后不再显著.上述骨代谢标志物变化特点未见显著的性别差异.ZOL对骨代谢的持续作用有待更长时间的随访观察.

Gender differences in bone metabolism of people with chronic obstructive pulmonary disease (COPD) remain unclear. We aim to explore the characteristics of bone metabolism and its clinical significance for patients with COPD. A total of 564 cases (282 COPD cases and 282 controls) were preselected. Clinical and analytical characteristics of these cases were assessed. After excluding patients with other conditions known to disturb calcium metabolism, 333 patients (152 COPD cases and 181 controls) were identified. The medical records, indexes of bone turnover markers, serum calcium and phosphorus of the 333 patients were collected and their correlation was analyzed. The 152 cases with COPD were 82.61 ± 7.745 years, 78.3% males, and the 181 age- and sex-matched control cases were 79.73 ± 11.742 years, 72.4% males. Levels of total procollagen type I amino-terminal propeptide (tPINP), osteocalcin (OC), serum calcium and phosphate were significantly lower (P < 0.001) while the level of parathormone (PTH) was significantly higher (P = 0.004) in COPD than in controls. The 25-hydroxycholecalciferol (25(OH)D3) was below the lower limit of normal value (LLN) in both groups, which was significantly lower in COPD males than in control males (P = 0.026). In COPD group, PTH level was significantly higher in females (P = 0.006), and serum P was lower in males (P = 0.006). The adjusted linear regression analysis showed that the levels of tPINP, OC and serum Ca were decreasing greatly in COPD group [β (95%CI) − 8.958 (− 15.255 to − 2.662), P = 0.005; − 4.584 (− 6.627 to − 2.542), P < 0.001; − 0.065 (− 0.100 to − 0.031), P < 0.001]. Besides, smoke exposure, gender (male) were also related to hypocalcemia [β (95%CI) − 0.025 (− 0.045 to − 0.005), P = 0.017; − 0.041 (− 0.083 to − 0.001), P = 0.047], and 25(OH)D3 was correlated with serum calcium, phosphorus, and PTH [β (95%CI) 15.392(7.032–23.753), P < 0.001; − 7.287 (− 13.450 to − 1.124), P = 0.021; − 0.103(− 0.145 to − 0.061), P < 0.001], and female was more likely to have secondary hyperparathyroidism [β (95%CI) 12.141 (4.047–20.235), P = 0.002]. COPD patients have remarkably low bone turnover (indicated by OC) and impaired bone formation (low tPINP), and they are also more prone to low calcium. Smoking and male may play roles in the formation of hypocalcemia, and the secondary hyperparathyroidism is more significant in COPD women. There may be gender differences in bone metabolism abnormalities and their mechanisms of COPD. The conclusion above still need further research and demonstration.

Medical image classification technology, preferably which is based on the deep learning, is not only a key auxiliary diagnosis and treatment method in clinical medicine but also an important direction of scientific research. With the intensification of social aging, the incidence of viral elderly pneumonia has been on the rise and needs dedication from the research community. Doctors rely on personal theories and experience to use traditional methods to check the computed tomography (CT) images of the lungs of elderly patients one by one, which is likely to cause diagnosis errors. The accuracy of the traditional method certainly meets the clinical needs, but it has higher requirements on the theory and experience of medical staff, and the classification efficiency is low. Constructing an accurate and fast auxiliary system can effectively save medical resources. In response to the above problems, we have proposed a viral pneumonia diagnosis method for lung CT images, which is based on the convolutional neural networks. The main research work is carried out around the following aspects: First, in the lung CT image classification task, the traditional methods are inefficient and effective for doctors. The basic quality requirements of the model are high, or, in the model training, the effective training data are small, and so forth, causing problems such as model overfitting. A lung CT classification model based on the improved Inception-ResNet is proposed. In this model, first the overall architecture of the network model is designed, and then the Contrast-Limited Adaptive Histogram Equalization (CLAHE) algorithm is used to perform the same image enhancement processing on the dataset and data needed in this article, and then the pictures pass through three different network models. A binary classification study was carried out on viral pneumonia and normal lung images, and finally the accuracy, sensitivity, and specificity of the three models were compared. The experimental results show that the accuracy of the three models for the judgment of viral pneumonia is more than 95%. Among these, the model proposed in this article has better classification effect and fit, the highest accuracy rate, and less parameters and can be used for rapid screening of viral senile pneumonia. Objective. To complete the classification of lung CT images of the elderly with viral pneumonia based on the improved Inception-ResNet network architecture. Methods. (1) Find and study domestic and foreign medical literature, understand the diagnosis and treatment methods of viral pneumonia, and study lung CT imaging; compare the pattern classifications of deep learning in lung imaging at home and abroad, and further study the application of convolutional neural networks in the medical field application. (2) Study various models and technologies of convolutional neural networks, summarize them separately, and have in-depth understanding of convolutional neural networks, including architecture, methods, and related system frameworks, experimental environments, and so forth. Results. This paper proposes an optimized Inception-ResNet network architecture for image classification. The control experimental model uses two network models, GoogLeNet and ResNet, and selects the viral pneumonia dataset for training and testing. The experimental results are as follows: the sensitivity and specificity are superior to those in the other two models, which can be used for actual medical screening and diagnosis. Conclusion. The improved Inception-ResNet network model method in this paper performs better in terms of accuracy, sensitivity, and specificity. Every metric is higher than those in the ResNet model and the GoogLeNet model, improving the classification effect. In addition, it can be seen from the experimental results that the model used in this paper has a very good classification effect in the classification of new coronary pneumonia CT image data.

目的 随着北京市空气质量的改善以及新冠疫情对呼吸道慢病管理与个人卫生习惯的影响,有必要对近年来医院慢性阻塞性肺疾病(COPD)入院患者的变化趋势及预后影响因素进行回顾性分析,为临床工作提供数据参考.方法 登录北京市生态环境监测中心官网,收集北京市2015～2020年度细颗粒物(PM2.5)、可吸入颗粒物(PM10.0)、二氧化硫(SO2)、二氧化氮(NO2)以及累计优良天数的公共数据信息;调取2015年1月～2020年12月北京积水潭医院诊断为COPD伴或不伴急性加重/肺部感染的所有病例(共1493例),进行回顾性研究.结果 COPD入院人数以12月至次年2月最多,之后逐步下降,7月达谷值;就年度变化趋势而言,从2017年开始COPD入院人数出现下降,2020年出现显著下降.相关性分析显示入院人数与空气质量指标PM2.5、PM10.0、SO2、NO2水平以及累计优良天数均呈显著相关(P＜0.05),COPD入院病死率从2018年呈现显著下降,入院病死率与PM2.5、PM100、NO2显著相关(P＜0.05);出院组与死亡组的年龄、日常生活能力评分(Barthel指数)、住院天数、存在慢性心功能不全、房颤、慢性肾功能不全、低蛋白血症7个变量比较,差异有统计学意义(P＜0.05).多因素logistic回归分析显示,NO2、房颤、慢性肾功能不全为COPD患者不良预后的独立危险因素(P＜0.05),入院时Barthel指数为其保护因素(P＜0.05).受试者工作特征曲线显示,入院时Barthel指数为37.5是不良预后的最佳风险预测截断值,特异度为75.5％,灵敏度为74.5％.结论 COPD疾病发展及预后与空气质量及个人卫生防护习惯相关.同时,日常生活能力评分(Barthel指数)可作为疾病风险预测特异性及敏感性均较好的指标,而合并肾功能不全及房颤的COPD患者临床应给予足够重视,避免不良预后.

BACKGROUND:To investigate the clinical values and relationships of bone turnover markers (BTMs), dual-energy X-ray absorptiometry (DXA), and quantitative computed tomodensitometry (QCT) in the screening of osteoporosis (OP) in elderly Chinese males.METHODS:General data, including age, height, and weight, the results of BTM measurements, and the findings of DXA and QCT in 357 male patients aged ≥50 years who visited the outpatient or inpatient Department of Geriatrics, Beijing Jishuitan Hospital from June 2017 to May 2019 were retrospectively analyzed.RESULTS:The OP detection rates based on T-scores of DXA L1-4, DXA total hip, and spine QCT were 3.4% (12/357), 13.2% (47/357), and 40.3% (144/357), respectively. QCT had a significantly higher OP detection rate than did DXA (P<0.001). There were 24 cases of fragility fractures, which were significantly correlated with the DXA total hip BMD and its T-score, with risk cut-off values of 0.607 g/cm2 and -2.950, respectively. The measured levels of the 5 BTMs were as follows: total procollagen type I amino-terminal propeptide (tPINP), 39.23±20.82 ng/mL; β-isomerized C-terminal telopeptides (β-CTX), 0.38±0.21 ng/mL; osteocalcin (OC), 13.50±8.80 ng/mL; 25-hydroxycholecalciferol (25(OH)D3), 12.90±7.46 ng/mL; and parathormone (PTH), 54.50±25.35 pg/mL. The elevation of tPINP, β-CTX, and OC were negatively correlated with aging and positively correlated with decreased BMD (all P<0.05). OC and 25(OH)D3 values were significantly lower than their normal range. Among the 43 patients with normal bone mass on both DXA and QCT examinations, 34 presented with abnormal BTMs, including elevated tPINP in 2 cases, elevated β-CTX in 2 cases, and OC decreased in 31 cases.CONCLUSIONS:In the Chinese elderly male population, spine QCT has a higher detection rate of OP than DXA, whereas hip DXA is more advantageous in predicting the risk of fragility fracture. tPINP, β-CTX, and OC can be used as reliable indicators for the dynamic observation of bone content changes and may screen for early bone metabolism abnormalities when BMD examinations still show negative results.

目的 探讨纤维支气管镜吸痰联合肺泡灌洗对高龄慢性阻塞性肺疾病(COPD)合并重症肺炎患者的临床疗效.方法 回顾性分析北京积水潭医院2018年6月至2020年9月收治的62例高龄COPD合并重症肺炎患者的临床资料.其中行抗感染,雾化吸入,按需吸痰管吸痰,维持水、电解质、酸碱平衡及营养支持等常规对症治疗32例(对照组),在常规对症治疗基础上接受纤维支气管镜吸痰联合肺泡灌洗治疗30例(观察组).比较2组治疗前和治疗5 d后血气分析指标[动脉血氧分压(PaO2)、氧合指数、动脉血二氧化碳分压(PaCO2)、乳酸]和炎症因子[白细胞计数(WBC)、C反应蛋白、降钙素原]水平,痰菌阳性率和临床疗效.结果 治疗前,2组动脉血气分析指标水平比较差异均无统计学意义(均P＞0.05);治疗后2组PaO2均高于治疗前、且观察组高于对照组[(74±8)mmHg(1 mmHg=0.133 kPa)比(66±8)mmHg],PaCO2和乳酸水平均低于治疗前、且观察组均低于对照组[(38±8)mmHg比(46±9)mmHg,(1.3±0.9)mmol/L比(1.9±l.l)mmol/L];治疗后观察组氧合指数高于本组治疗前和对照组[(269±82)比(196±74)、(189±90)](均P＜0.05).治疗前,2组WBC、C反应蛋白和降钙素原水平比较差异均无统计学意义(均P＞0.05);治疗后2组WBC和C反应蛋白水平均低于治疗前、且观察组均低于对照组,治疗后观察组降钙素原水平低于本组治疗前和对照组(均P＜0.05).观察组痰菌阳性率和总有效率均高于对照组[93.3％(28/30)比59.4％(19/32),93.3％(28/30)比62.5％(20/32)](均 P＜0.05).结论 纤维支气管镜吸痰联合肺泡灌洗治疗可有效改善高龄COPD合并重症肺炎患者氧合情况,减轻机体炎症反应,提高痰菌阳性率和疗效.

Background Elderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. The current study was to investigate the etiology and bacterial drug resistance patterns of elderly patients with hip fractures and lower respiratory tract infections on prolonged bedridden time and to determine their prognosis. Methods Patients diagnosed with hip fractures admitted from May 2015 to April 2017 were included. The basic characteristics including the patients’ gender, age, fracture type, operation mode, bedridden duration, length of hospital stay, prognosis, past medical history, routine bloodwork, C-reactive protein (CRP), procalcitonin (PCT), blood biochemistry, blood gas analysis, glycosylated hemoglobin (HbA1C%), sputum smear, sputum culture, and anti-infection and related therapy were recorded. All patients were classified into three groups based on bed rest duration, including short-term (<1 month), mid-term (1–12 months), and long-term (> 12 months). The correlation between the bedridden time and the patients’ basic characteristics, disease history, laboratory examination results, pathogen, anti-infection, and related therapy were evaluated. The risk factors related to the prognosis of the disease were investigated. Results Prolonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels ( P < 0.05). Sputum bacteriological culture results showed that, with bed rest prolongation, the proportion of Pseudomonas aeruginosa and fungal infections increased. Binomial logistic regression of pulmonary infection prognosis, glucocorticoid use during the anti-infective period, prolonged bedridden time, and serum albumin level showed that intravenous use of glucocorticoid during anti-infective treatment, bed rest > 1 year, and low serum albumin level were related to poor prognosis. Conclusion Elderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. Glucocorticoids should be used cautiously.

目的 探讨高龄男性慢性阻塞性肺疾病(COPD)患者的骨密度情况及相关影响因素.方法 选择北京积水潭医院老年科2019年1月～2019年6月门诊或病房诊治的47例高龄男性COPD稳定期患者为研宄对象.采集患者基本信息、血常规、生化、C反应蛋白(CRP)、血气分析、糖化血红蛋白、VitD水平,腰椎、髋部骨密度测定及肺功能检查.结果 47例COPD患者平均年龄(84.89±5.21)岁,BMI(24.06±2.04)kg/m2,有吸烟史者63.83％,吸烟指数平均417.02±60.06,戒烟比例87.2％,正在使用吸入激素的比例为17.02％;25(OH)D3(11.723±5.60)ng/ml、CRP(6.15±3.330)mg/L;腰椎总体骨密度值为(1.393±0.256)g/cm2,T值为0.862±0.192;髋部总体骨密度值为(0.950±0.198)g/cm2,T值为-0.321±0.522;FEV1％(63.383±7.061)％,FEV1/FVC(57.021±7.078)％,DLCO％(71.511±5.247)％,FVC％(82.96±10.61)％,RV/TLC(58.787±7.014)％;血气分析PaCO2(39.264±3.792)mmHg,PaO2(76.017±9.446)mmHg;logistic回归分析以腰椎总体骨密度值为因变量分析得出BMI减低、CRP升高、VitD缺乏、FVC％减低及DLCO％减低均为高龄COPD患者骨密度下降的独立危险因素;以髋部总体骨密度值为因变量分析得出增龄、吸入激素、白蛋白减低、VitD缺乏、RV/TLC升高及DLCO％减低均为高龄COPD患者骨密度下降的独立危险因素.结论 高龄男性COPD患者存在增龄、VitD缺乏、营养状况不佳及激素使用等致骨密度减低的独立危险因素,临床上应做好早期筛查及诊治工作.与此同时稳定期C RP水平、阻塞性通气功能障碍及肺气肿严重程度、肺弥散功能均与其骨密度减低独立相关,提示COPD与骨代谢之间可能存在多途径的相互作用机制,有待进一步研究.

WHAT IS KNOWN AND OBJECTIVE:Ceritinib is a new, oral, potent and selective second-generation anaplastic lymphoma kinase (ALK) inhibitor approved by the Food and Drug Administration of the United States in April 2014. It is active in crizotinib-resistant patients, especially in patients with non-small cell lung cancer (NSCLC) and brain metastasis. The aim of this study was to analyse the effects and side effects of ceritinib in ALK-rearranged NSCLC. METHODS:We searched articles published from January 1980 to March 2019 in PubMed, EMBASE, Cochrane Library and Web of Science. The pooled estimate and 95% CI were calculated with DerSimonian-Laird method and the random effect model. RESULTS AND DISCUSSION:From 15 articles, 2,598 patients were included in the meta-analysis. Eleven studies reported the ORR, and the DCR was presented in 10 studies. The ORR and DCR of ceritinib were 0.48 (95% CI, 0.39-0.57) and 0.76 (95% CI, 0.69-0.82), respectively. The PFS and OS were presented in nine and three eligible studies, respectively. The PFS and OS of ceritinib were 7.26 months (95% CI, 5.10-9.43) and 18.73 months (95% CI; 14.59-22.87). These results suggested that ceritinib can effectively treat patients with ALK-rearranged NSCLC. Diarrhoea, nausea and vomiting were the three most common AEs and occurred in 69% (95% CI 51.7-87.1%), 66% (95% CI 47.0-85.8%) and 51% (95% CI 35.9-66.8%) of patients, respectively. Considering serious gastrointestinal AEs, antiemetic and antidiarrhoeal drugs should be considered to improve a patient's tolerance to ceritinib. WHAT IS NEW AND CONCLUSION:Ceritinib is effective in the treatment of patients with ALK-rearranged NSCLC with crizotinib resistance. The DCR was up to 76%, and PFS was extended to 7.6 months. The AEs were acceptable.

目的 探讨血清胆碱酯酶(S-ChE)、C反应蛋白( CRP)在老年肺部感染患者诊断及预后评估中的价值.方法 选取2016—2018年于北京积水潭医院干部科接受治疗的200例肺部感染患者纳入B组,选取同期体检的无肺部感染的健康老年体检者200例纳入A组.根据临床肺部感染(CPIS)评分将B组患者分为评分＞6分组(n=128)与评分≤6分组( n=72)两个亚组.根据治疗后30 d内患者病情严重程度将B组患者分为好转组( n=159)与死亡组( n=41)两个亚组.比较各组患者血清S-ChE、CRP水平.根据Pearson相关性检验分析血清S-ChE、CRP水平与老年肺部感染患者病情严重程度的相关性.分析血清S-ChE、CRP及S-ChE联合CRP在老年肺部感染患者预后评估的价值.结果 B组血清S-ChE水平明显低于A组,CRP水平明显高于A组,两组比较,差异均有统计学意义( P＜0.05).评分≤6分组血清S-ChE水平明显高于评分＞6分组,CRP水平明显低于评分＞6分组,两组比较,差异均有统计学意义(P＜0.05).好转组血清S-ChE水平明显高于死亡组,CRP水平明显低于死亡组,两组比较,差异均有统计学意义(P＜0.05).血清S-ChE水平与病情严重程度呈负相关,CRP水平与病情严重程度呈正相关(P＜0.05).结论 老年肺部感染患者血清S-ChE水平明显降低,CRP水平明显升高,其对患者诊断及预后评估均具有一定价值.

Objective To investigate the clinical characteristics and risk factors for pulmonary infection in elderly patients with hip fracture after the treatment through a model of orthopedic-geriatric co-care,in order to provide prevention and control strategies.Methods Clinical data and laboratory results of elderly patients with hip fractures admitted into our hospital from January 2016 to May 2016 were collected.The differences in treatment outcome and adverse reactions were retrospectively compared between the two groups of patients with versus without pulmonary infection,and univariate and multivariate analysis of lung infection were performed.Results Of 207 patients,43 were infected with pneumonia and 164 were not.The proportion of patients with the time interval＜48 h from admission to surgery was 48.6％ (86/177),and the time interval＜ 1 week from admission to surgery was 98.9％ (175/177).The average length of hospital stay was(7.9±3.5)days.There was no significant difference in the time interval from admission to surgery,the time spent on surgery,length of hospital stay,surgical procedure and inflammatory indicators between the pneumonia and non-pneumonia groups.Univariate analysis showed that advanced age,multiple primary diseases,primary lung diseases,chronic respiratory failure,cerebrovascular disease,sequelae of cerebrovascular disease,immune system disease or long-term oral hormone therapy and preoperative anemia were risk factors for pulmonary infection in elderly patients with hip fracture (P ＜ 0.05 or＜ 0.01).Multivariate regression analysis showed that advanced age(OR =1.239,95％ CI:1.016 ～ 1.595,P =0.051),preoperative anemia(OR =2.491,95％ CI:1.148～ 5.403,P =0.021),sequelae of cerebrovascular disease (OR =3.987,95％ CI:1.354 ～11.741,P=0.012),primary lung diseases(OR =4.404,95％ CI:1.800 ～ 11.078,P =0.001) and immune system diseases (OR =17.166,95 ％ CI:1.750 ～ 168.409,P =0.015) were independent risk factors for pulmonary infection in elderly patients with hip fracture.Conclusions The orthopedic-geriatric co-care model seems to be in favour of controlling the progress of pulmonary infection in elderly patients with hip fracture,and to shorten waiting time before surgery and length of hospital stay.However,advanced age and chronic diseases are unpreventable risk factors for pulmonary infection in elderly patients with hip fractures.Clinicians should pay attention to the high-risk population and take prevention and control strategies to prevent the occurrence and development of lung infections.

目的 探讨老年长期卧床患者继发肺部感染的临床及病原学特点,以及影响预后的独立危险因素.方法 回顾性分析2013年4月1日～ 2014年4月1日因肺部感染入院的、患者年龄≥65岁、卧床时间＞3个月的患者,共58例,分为低龄老年组(≤80岁)及高龄老年组(＞ 80岁),比较组间临床及实验室等特点的差异;并对肺部感染预后的相关危险因素进行多因素回归分析.结果 58例患者男女性别比为34∶24,患者平均年龄80±8岁,卧床时间中位数为12个月,病死率13.8％ (8/58).100％的患者有新发咳嗽咳痰或原有咳嗽咳痰加重,临床起病以低热为主(30例,55.6％),入院1周内谵妄、显性呛咳比例分别为53.4％ (31/58)及58.6％ (34/58).入院后首次化验显示高龄组CRP及动脉血二氧化碳分压(PaCO2)均高于低龄组,而血肌酐水平低于正常范围及高于正常范围的比例均高于低龄组.影像学以双侧渗出为主(37例,63.8％).致病细菌中,G-杆菌感染居首位(46例,79.3％),G+球菌次之(11例,19％).真菌感染31例(53.4％),白假丝酵母菌最常见(19例,61.3％).多因素回归分析显示,有COPD病史、入院前已留置导尿、入院后血肌酐水平高于正常、首次动脉血pH＞ 7.446、首次动脉血氧分压(PaO2)＜79mmHg、入院后需肠外营养支持、合并真菌感染及双肺受累是长期卧床老年患者继发肺部感染预后不佳的独立危险因素.结论 老年长期卧床患者继发肺部感染的发生率、病死率高,加之临床特点不典型容易漏诊或延迟诊断,临床医师应尽可能做到及早发现、严密监测并有针对性地给予相应治疗.

目的 探讨老年重症肺炎患者血小板减少与应用利奈唑胺是否相关.方法 调查1例重症肺炎患者抢救过程中的治疗及临床资料,该患者在肺炎加重期与恢复期分别两次应用利奈唑胺,期间监测血小板计数,并观察其变化.结果 患者第1次应用利奈唑胺抗感染时是炎症反应高峰期,期间维持呼吸机辅助呼吸,血小板计数已有下降,同时合并肾功能不全、呼吸衰竭等,应用利奈唑胺6d后血小板计数进一步下降为60×109/L,停用利奈唑胺改用替考拉宁治疗,4d后血小板仍继续下降至39×109/L,经输注血小板及随病情好转血小板恢复至正常;血小板恢复正常28d后由于感染未完全控制,第2次应用利奈唑胺,治疗11d 血小板均正常.结论 重症肺炎患者应用利奈唑胺与出现血小板计数下降并不是简单的因果关系,而是与全身的感染状况密切相关,此时药物的选择及是否需要停药等应综合考虑患者各方面情况,同时密切监测血小板计数以便适时停药.