乙型肝炎病毒相关肝功能衰竭合并侵袭性肺曲霉菌病的临床特点与转归  

Clinical analysis of patients with hepatitis B virus-related liver failure complicated with invasivepulmonary aspergillosis

作　　者：王玮[1] 赵彩彦[1] 王亚东[1] 尹洪竹[1] 刘英辉[1] 周俊英[1] 

机构地区：[1]河北医科大学第三医院感染科,石庄市 050051

出　　处：《中华传染病杂志》2011年第1期34-40,共7页Chinese Journal of Infectious Diseases

摘　　要：目的探讨HBV相关肝功能衰竭合并侵袭性肺曲霉菌病（IPA）的临床特征、危险因素、诊治及预后。方法采用病例对照研究的方法，回顾性分析43例HBV相关肝功能衰竭合并IPA患者的临床特征、危险因素、诊治经过、预后及转归等，并选取同期住院的43例HBV相关肝功能衰竭合并单纯细菌感染患者以及43例未合并感染的HBV相关肝功能衰竭患者作为对照。计量资料采用方差分析，计数资料采用卡方检验，多因素分析采用Logistic回归分析。结果合并感染的HBV相关肝功能衰竭患者PTA和PLT显著下降，MELD评分升高，尤以IPA组患者为著，合并1PA前后的对比结果亦是如此。IPA组患者1年内病死率为100．0％，明显高于单纯细菌感染组的65．10％，两者均高于未合并感染组的39．50％；Logistic回归分析结果显示，住院时间延长、使用大量抗菌药物、侵入性操作频繁等是HBV相关肝功能衰竭合并IPA的危险因素。结论HBV相关肝功能衰竭患者合并IPA后病情迅速恶化、病死率高、预后差，提高对其早期表现的认知度，尽早诊断和进行强有力的抗真菌治疗，是提高HBV相关肝功能衰竭合并IPA患者牛存率的有效方法。Objective To investigate the clinical features, risk factors, diagnose, treatments and prognosis of patients with hepatitis B virus （HBV） related liver failure complicated with invasive pulmonary aspergillosis （IPA）. Methods A case control study was performed to retrospectively analyze the clinical data of 43 patients with HBV-related liver failure complicated with IPA. A cohort of 43 patients with HBV-related liver failure complicated with bacterial infection only was analyzed at the same time and another cohort of 43 patients with HBV-related liver failure without any infections served as the control group. Results Compared with the control group, patients with infection had lower platelet counts and prothrombin activity, higher scores of model for end-stage liver disease （MELD）, especially the patients withlPA （F=42.43,13.69,14.22, all P〈0.01）. And the similar results were observed in patients with IPA group before and after Aspergillgus infection （F= 12.09, 14.52, 16. 74, all P〈0.01）. Furthermore, the annual mortality was 100.0% in patients with IPA, which was higher than that of patients complicated with bacterial infection only; and both groups were higher than control group of patients without infection. The statistic results showed that patients with longer length of stay, more antibiotics usage, and more invasive procedures were all risk factors of HBV related liver failure complicated with IPA. Conclusions Conditions of patients with HBV-related liver failure deterioraterapidly after complicated with IPA and patients have higher mortality and poorer prognosis. Therefore, it will he effective to enhance the recognition of the early clinical manifestations, and make diagnosis timely and treat with potent anti fungal therapy to improve their survival.

关 键 词：肝炎病毒 乙型 肝功能衰竭 肺疾病 真菌性 曲霉菌病 抗真菌药 

分 类 号：R575[医药卫生—消化系统] R51[医药卫生—内科学]