Analysis of Clinical Characteristics and Prognostic Risk Factors in Patients with Pulmonary Mucormycosis Complicated with Diabetes Mellitus

doi:10.12114/j.issn.1007-9572.2025.0410

Abstract

Abstract:

Background

Pulmonary mucormycosis (PM) is a highly invasive fungal infection, which is characterized by rapid progress and high mortality. Diabetes mellitus (DM) is a major predisposing factor, especially under the condition of poorly control. It is difficult to diagnose the disease early because of the lack of specificity in clinical manifestations and imaging features. This is easy to delay diagnosis and treatment, leading to poor prognosis. However, data on the clinical characteristics and prognostic factors of PM in patients with DM remain scarce.

Objective

To investigate the clinical characteristics of PM in patients with DM and to identify the independent risk factors for 28-day mortality.

Methods

This retrospective study included 51 hospitalized patients who were proven or probable PM diagnosed according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria at Jinan Central Hospital between May 2015 and May 2025. Patients were divided into two groups: a PM with DM group (PM+DM, n=24) and a PM without DM group (PM+NDM, n=27). Clinical characteristics, laboratory findings, imaging features, and treatment regimens of the two groups were compared. Univariate and multivariable Cox regression analyses were performed to identify independent risk factors for 28-day mortality in the PM with DM group.

Results

No significant differences were observed between the PM+DM and PM+NDM groups in baseline characteristics, clinical features, or treatment regimens (P>0.05). Compared with the PM+NDM group, the PM+DM group had significantly higher levels of high-sensitivity C-reactive protein, and arterial partial pressure of carbon dioxide, HbA_1c, fasting blood glucose, and serum galactomannan (GM) test results (P<0.05), but significantly lower albumin levels and thrombin time (P<0.05). There was no significant differences were found in the other laboratory parameters (P>0.05). In terms of imaging findings, the proportions of patients with involvement of three or more lung lobes and pulmonary cavitary lesions were significantly higher in the PM+DM group than that in the PM+NDM group (P<0.05). However, no significant between-group differences were found in reversed halo sign, pulmonary nodules, or other imaging manifestations (P>0.05). Multi-variable analysis identified HbA_1c and serum creatinine levels as independent predictors of 28-day mortality in the PM+DM group (P<0.05).

Conclusion

Patients with pulmonary mucormycosis complicated by diabetes mellitus are characterized by a heightened inflammatory response, hypoalbuminemia, poor glycemic control, pulmonary cavitary lesions, and multi-lobar involvement. HbA_1c and serum creatinine levels may serve as important predictors of 28-day mortality.

Key words: Pulmonary mucormycosis, Lung diseases, fungal, Mucormycosis, Diabetes mellitus, Clinical characteristics, Prognosis, Risk factors

摘要：

背景

肺毛霉病（PM）是一种起病急、进展快且病死率较高的侵袭性真菌感染，糖尿病是其重要易感因素，尤以血糖控制不佳者风险更高。由于该病临床表现及影像学特征缺乏特异性，早期诊断较为困难，易延误诊治，导致预后不良。目前关于PM合并糖尿病患者临床特征及预后影响因素的研究相对有限，尚缺乏系统性总结。

目的

探讨PM合并糖尿病患者的临床特征，并分析影响其28 d全因死亡的独立危险因素，为临床早期识别与个体化治疗提供依据。

方法

选取2015年5月—2025年5月于济南市中心医院住院的符合欧洲癌症研究与治疗组织/真菌研究组诊断标准中"确诊"或"临床诊断"的PM患者共51例，根据是否合并糖尿病分为PM合并糖尿病组（PM+DM组）24例与PM不合并糖尿病组（PM+NDM组）27例。比较两组患者的临床特征、实验室指标、影像学表现及治疗方式，采用单因素及多因素Cox比例风险回归分析PM+DM组患者28 d全因死亡的危险因素。

结果

PM+DM组与PM+NDM组在基本资料、临床特征及治疗方案上比较，差异无统计学意义（P>0.05）；在实验室检查指标方面，PM+DM组C反应蛋白、动脉二氧化碳分压、糖化血红蛋白、空腹血糖、曲霉菌血清实验结果高于PM+NDM组（P<0.05）；PM+DM组白蛋白、凝血酶时间低于PM+NDM组（P<0.05）；其他实验室指标比较，差异无统计学意义（P>0.05）；影像学上，PM+DM组受累肺叶数目≥3叶患者比例、肺空洞发生患者比例较PM+NDM组患者更高（P<0.05）。PM+DM组和PM+NDM组在反晕轮征、肺结节等影像学表现比较，差异无统计学意义（P>0.05）。多因素分析显示，糖化血红蛋白及肌酐值是PM+DM组患者28 d全因死亡的独立危险因素（P<0.05）。

结论

PM合并糖尿病患者主要表现为高炎症状态、低蛋白血症、血糖控制不佳及肺部空洞性病变及多肺叶受累等情况；糖化血红蛋白及肌酐值是PM合并糖尿病患者28 d全因死亡的危险因素。

关键词: 肺毛霉病, 肺疾病，真菌性, 毛霉菌病, 糖尿病, 疾病特征, 预后, 危险因素

WANG Xinliang,ZOU Nannan,CHEN Nana, et al. Analysis of Clinical Characteristics and Prognostic Risk Factors in Patients with Pulmonary Mucormycosis Complicated with Diabetes Mellitus[J]. Chinese General Practice, 2026, 29(22): 3154-3161. DOI: 10.12114/j.issn.1007-9572.2025.0410.
王欣亮,邹楠楠,陈娜娜等. 肺毛霉病合并糖尿病的临床特征及预后危险因素研究[J]. 中国全科医学, 2026, 29(22): 3154-3161. DOI: 10.12114/j.issn.1007-9572.2025.0410.

Figures/Tables 7

References 32

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组别	例数	年龄（±s，岁）	BMI[M（Q₁，Q₃），kg/m²]	诊断时间[M（Q₁，Q₃），d]	性别（男/女）	吸烟史[例（%）]	饮酒史[例（%）]	3个月内糖皮质激素使用史[例（%）]	慢性阻塞性肺疾病[例（%）]	新型冠状病毒感染[例（%）]	死亡[例（%）]
PM+NDM组	27	61.4±19.3	23.46（21.12，25.89）	7（6，8）	18/9	6（22.2）	5（18.5）	5（18.5）	4（14.8）	1（3.7）	9（33.3）
PM+DM组	24	59.7±16.8	21.19（19.10，26.30）	8（7，9）	18/6	7（29.2）	5（20.8）	3（12.5）	2（8.3）	4（16.7）	10（41.7）
检验统计量值		0.333^a	-1.096^b	-1.452^b	0.425	0.323	0.043	—	—	—	0.377
P值		0.741	0.273	0.147	0.514	0.570	0.835	0.707	0.671	0.175	0.539

组别	例数	年龄（±s，岁）	BMI[M（Q₁，Q₃），kg/m²]	诊断时间[M（Q₁，Q₃），d]	性别（男/女）	吸烟史[例（%）]	饮酒史[例（%）]	3个月内糖皮质激素使用史[例（%）]	慢性阻塞性肺疾病[例（%）]	新型冠状病毒感染[例（%）]	死亡[例（%）]
PM+NDM组	27	61.4±19.3	23.46（21.12，25.89）	7（6，8）	18/9	6（22.2）	5（18.5）	5（18.5）	4（14.8）	1（3.7）	9（33.3）
PM+DM组	24	59.7±16.8	21.19（19.10，26.30）	8（7，9）	18/6	7（29.2）	5（20.8）	3（12.5）	2（8.3）	4（16.7）	10（41.7）
检验统计量值		0.333^a	-1.096^b	-1.452^b	0.425	0.323	0.043	—	—	—	0.377
P值		0.741	0.273	0.147	0.514	0.570	0.835	0.707	0.671	0.175	0.539

组别	例数	咳嗽、咳痰	呼吸困难	发热	胸闷、胸痛	咯血	意识障碍
PM+NDM组	27	25（92.6）	18（66.7）	26（96.3）	12（44.4）	10（37.0）	4（14.8）
PM+DM组	24	20（83.3）	17（70.8）	21（87.5）	11（45.8）	11（45.8）	5（20.8）
χ²值		1.049	0.102	1.360	0.010	0.406	0.317
P值		0.306	0.772	0.244	0.921	0.524	0.574

组别	例数	咳嗽、咳痰	呼吸困难	发热	胸闷、胸痛	咯血	意识障碍
PM+NDM组	27	25（92.6）	18（66.7）	26（96.3）	12（44.4）	10（37.0）	4（14.8）
PM+DM组	24	20（83.3）	17（70.8）	21（87.5）	11（45.8）	11（45.8）	5（20.8）
χ²值		1.049	0.102	1.360	0.010	0.406	0.317
P值		0.306	0.772	0.244	0.921	0.524	0.574

指标	PM+NDM组（n=27)	PM+DM组（n=24)	t（Z）值	P值
白细胞计数[M（Q₁，Q₃），×10⁹/L]	7.77（5.88，9.94）	4.78（4.28，10.35）	-0.915^a	0.360
中性粒细胞计数[M（Q₁，Q₃），×10⁹/L]	5.71（3.60，7.78）	3.39（2.84，8.90）	-0.717^a	0.473
淋巴细胞计数[M（Q₁，Q₃），×10⁹/L]	1.28（0.78，1.90）	0.95（0.70，1.15）	-1.340^a	0.180
单核细胞计数[M（Q₁，Q₃），×10⁹/L]	0.52（0.27，0.79）	0.55（0.38，0.57）	-0.472^a	0.637
嗜酸粒细胞计数[M（Q₁，Q₃），×10⁹/L]	0.07（0.02，0.20）	0.03（0.01，0.16）	-1.450^a	0.147
嗜碱粒细胞计数[M（Q₁，Q₃），×10⁹/L]	0.01（0.01，0.03）	0.02（0.01，0.05）	-0.499^a	0.618
血小板计数（±s，×10⁹/L）	245.07±133.13	236.00±148.63	-0.229	0.819
红细胞计数[M（Q₁，Q₃），×10¹²/L]	3.96（3.60，4.25）	3.43（2.89，4.68）	-0.585^a	0.558
血红蛋白（±s，g/L）	119.07±21.56	103.39±35.29	1.939	0.058
CRP[M（Q₁，Q₃），mg/L]	43.65（28.40，59.22）	78.50（43.90，103.00）	-2.615^a	0.009
丙氨酸氨基转移酶[M（Q₁，Q₃），U/L]	23.05（13.50，33.25）	15.20（12.00，43.00）	-1.085^a	0.278
天冬氨酸氨基转移酶[M（Q₁，Q₃），U/L]	22.65（14.80，42.00）	22.00（13.10，37.00）	-0.699^a	0.485
碱性磷酸酶[M（Q₁，Q₃），U/L]	78.00（71.90，101.00）	85.00（75.00，104.00）	1.852^a	0.064
乳酸脱氢酶（±s，U/L）	381.41±146.45	372.42±114.32	0.242	0.810
γ-GT[M（Q₁，Q₃），U/L]	50.50（28.00，71.75）	71.00（33.00，114.00）	-0.538^a	0.591
白蛋白[M（Q₁，Q₃），g/L]	36.20（32.0，40.10）	29.35（28.12，32.40）	-4.106^a	<0.001
肌酐值[M（Q₁，Q₃），μmol/L]	55.60（39.70，81.50）	51.60（44.00，82.00）	-0.821^a	0.412
D-二聚体[M（Q₁，Q₃），μg/L]	0.76（0.49，1.64）	1.50（0.49，3.95）	-1.595^a	0.111
动脉血氧分压（±s，mmHg）	85±10	86±8	-0.371	0.712
动脉二氧化碳分压（M（Q₁，Q₃），mmHg）	36（34，41）	42（38，48）	-3.358^a	<0.001
乳酸[M（Q₁，Q₃），mmol/L]	2.85（1.10，4.90）	1.50（1.00，2.80）	-1.549^a	0.121
HbA_1c（±s，%）	5.48±0.55	8.54±1.32	-10.568	<0.001
空腹血糖[M（Q₁，Q₃），mmol/L]	5.62（4.74，5.88）	10.19（9.65，13.33）	-5.703^a	<0.001
曲霉菌血清实验[M（Q₁，Q₃）]	0.11（0.07，0.17）	0.19（0.13，0.67）	-3.192^a	0.001
凝血酶时间（±s，s）	17.89±1.41	17.03±1.61	^2.036	0.047