肝衰竭并发多系统侵袭性真菌感染临床分析  

Liver failure complicated by multi-system invasive fungal infections

作　　者：苏海滨[1] 王慧芬[1] 李晨[1] 赵鸿[1] 林芳[1] 闫涛[1] 牟劲松[1] 李雷[1] 许海苗[1] 

机构地区：[1]解放军第三0二医院肝衰竭治疗研究中心,北京100039

出　　处：《传染病信息》2010年第2期95-97,共3页Infectious Disease Information

基　　金：军队"十一五"中医药研发推广专项重大临床攻关项目(2006231001);国家"十一五"科技重大专项(2008ZX10002-005-6)

摘　　要：目的分析肝衰竭并发多系统侵袭性真菌感染(invasive fungal infections,IFI)的临床特征。方法回顾性分析1985年1月-2009年12月我院收治的肝衰竭并发多系统IFI患者的临床资料,总结临床特点,分析抗真菌疗效影响因素。结果发生2个系统以上IFI共73例。其中发生2个系统IFI54例(74.0%),3个系统16例(21.9%),4个系统3例(4.1%)。患者在发生真菌感染前均有使用抗生素史。以肺部感染最为多见(36.5%),其次为消化道(22.8%)、泌尿道(19.8%)、血液(11.4%)及腹腔(9.6%)。共分离菌株84株,其中酵母样菌62株(73.8%),为最常见菌株。60例(82.2%)在不同系统中分离出1种菌株,10例(13.7%)分离出2种菌株,2例(2.7%)分离出3种菌株,1例(1.4%)分离出4种菌株。抗真菌治疗有效率为35.6%,基础疾病治愈好转率为21.9%。抗真菌疗效与是否并发肝性脑病和抗真菌药物使用时间是否>14d有关。结论对于肝衰竭患者,应注重多系统IFI的监测。对于肝衰竭并发多系统IFI,应在重视基础疾病治疗的基础上,合理选用抗真菌药物并维持适当的疗程。Objective To evaluate the clinical characteristics of liver failure complicated by multi-system invasive fungal infection （IFI） and the factors affecting the therapeutic efficacy. Method The case data of the patients with liver failure complicated by multi-system IFI in our hospital form Jan. 1985 to Dec. 2009 were retrospectively analyzed. Results A total of 73 patients with liver failure were identified as having IFI in more than 2 systems, among whom 54 （74.0%） developed IFI in 2 systems, 16 （21.9%） in 3 systems, and 3 （4.1%） in 4 systems. All the patients had been treated with antibiotics before IFI was confirmed. Of the patients, 36.5% developed IFI in the lungs, 22.8% in the digestive tract, 19.8% in the urinary tract, 11.4% in the blood and 9.6% in the peritoneal cavity. A total of 84 fungal strains were isolated and Saccharomycopsis was the most common, accounting for 73.8%. One strain was isolated from different systems in 60 patients （82.2%）, 2 strains in 10 patients （13.7%）, 3 strains in 2 patients （2.7%） and 4 strains in 1 patient （1.4%）, respectively. Antifungal therapy was effective in 35.6% of the patients and underlying disease improved in 21.9% of the patients. The effect of antifugal therapy was correlated with whether or not hepatic encephalopathy was complicated by and the duration of antifungal therapy was more than 14 days. Conclusions Multi-system IFI should be monitored in the patients with liver failure. Reasonable use of antifungal agents and appropriate duration of antifungal therapy based on the treatment of underlying diseases are essential for the paitents with liver failure complicated by multi-system IFI.

关 键 词：肝功能衰竭 真菌病 抗真菌药 治疗结果 

分 类 号：R575.3[医药卫生—消化系统] R379[医药卫生—内科学]