慢加急性肝衰竭并发侵袭性真菌感染患者临床特点及其影响因素分析

doi:10.3969/j.issn.1672-5069.2021.04.017

摘要/Abstract

摘要： 目的分析慢加急性乙型肝炎肝衰竭(HBV-ACLF)并发侵袭性真菌感染患者的临床特点及其影响因素。方法 2017年1月～2020年1月我院收治的HBV-ACLF患者130例,使用迪尔鉴定仪鉴定真菌种类,采用多因素Logistic回归分析影响ACLF患者并发侵袭性真菌感染的危险因素。结果在本组130例HBV-ACLF患者中,并发侵袭性真菌感染50例(38.5%),其中,上呼吸道和肺部感染24例(48.0%),肠道感染14例(28.0%),泌尿道感染7例(14.0%),血流感染4例(8.0%),腹腔感染1例(2.0%);白色念珠菌26株(52.0%),另有热带念珠菌8株(16.0%),近平滑念珠菌6株(12.0%),季也蒙念珠菌5株(10.0%),黄曲霉菌3株(6.0%)和毛霉菌2株(4.0%);并发侵袭性真菌感染患者年龄≥40岁和长时间应用抗生素占比显著多于未并发真菌感染患者(P<0.05),血清总胆红素和凝血酶原时间显著高于或长于未并发患者,而血清白蛋白水平显著低于未并发真菌感染组(P<0.05);多因素Logistic回归分析显示,年龄≥40岁(OR=3.332)、血清总胆红素水平过高(OR=4.525)和长时间应用抗生素(OR=1.576)为ACLF患者并发侵袭性真菌感染的危险因素(P<0.05)。结论 HBV-ACLF患者存在容易并发侵袭性真菌感染的危险因素,了解感染的常见部位和常见菌株有助于临床早期预防,及时处理,提高生存率。

关键词: 慢加急性肝衰竭, 侵袭性真菌感染, 临床特征, 影响因素

Abstract: Objective This paper aimed to investigate the clinical features and influencing factors of invasive fungal infections (IFI) in patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF). Methods The clinical data of 130 patients with HBV-ACLF admitted in our hospital between January 2017 and January 2020 were collected and analyzed retrospectively. The incidence, location and species of IFI in patients with ACLF were documented. The multivariate Logistic regression analysis was applied analyze the risk factors for IFI in patients with ACLF. Results Out of the 130 patients with HBV-ACLF in our series, the incidence of IFI was 38.5%, and the common infection sites were in upper respiratory tract and lung infection in 24 cases(48.0%), gut infection in 14 cases(28.0%), urinary tract infection in 7 cases(14.0%), blood infection in 4 cases (8.0%) and peritoneal infection in 1 case(2.0%); the most common pathogenic bacteria was the Candida albicans in 26 cases(52.0%); the percentages of age older than 40 year and long-term administration of antibiotics in patients with IFI were significantly higher than in patients without (P<0.05), total serum bilirubin and prothrombin time were significantly higher or longer than, while serum albumin level was much lower than in patients without IFI(P<0.05); multivariate Logistic regression analysis showed that older than 40 year (OR=3.332), incredible hyperbilirubinemia (OR=4.525) and long-term intravenous administration of antibiotics(OR=1.576) were the independent risk factors for IFI in patients with ACLF(P<0.05). Conclusion The main sites of invasive fungal infection in patients with HBV-ACLF are upper respiratory tract and lung, and the main common pathogenic bacteria is Candida albicans. The peripheral blood white blood cell counts, serum bilirubin levels, and PT increase or elongated. The patients’ age older than 40 year, intravenous infusion of antibiotics longer than 4 weeks and excessive high serum bilirubin levels are the risk factors for invasive fungal infection in patients with HBV-ACLF. Therefore, targeted preventive measures should be taken to deal with them, which might reduce the complications and improve the prognosis.

Key words: Acute-on-chronic liver failure, Invasive fungal infection, Clinical feature, Risk factor

利振坤, 何吕芬, 李欢, 符晓莹, 王身华, 吴智明. 慢加急性肝衰竭并发侵袭性真菌感染患者临床特点及其影响因素分析[J]. 实用肝脏病杂志, 2021, 24(4): 520-523.

Li Zhenkun , He Lyufen, Li Huan, et al. Clinical features and influencing factors of invasive fungal infections in patients with acute-on-chronic hepatitis B liver failure[J]. Journal of Practical Hepatology, 2021, 24(4): 520-523.

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