中国南方地区乙肝肝衰竭患者医院内真菌感染的临床特征分析  

Clinical features of nosocomial mycotic infection in patients with hepatitis B virus-induced liver failure in South China

作　　者：彭亮[1] 刘静[1] 高志良[1] 

机构地区：[1]中山大学附属第三医院感染性疾病科,510630

出　　处：《新医学》2011年第5期287-290,共4页Journal of New Medicine

摘　　要：目的:初步分析中国南方地区乙型病毒性肝炎(乙肝)导致的肝衰竭患者医院内真菌感染的临床特征。方法:收集2005年7月-2010年6月诊断为乙肝肝衰竭的876例住院患者的临床资料,调查乙肝肝衰竭合并真菌感染患者的病死率,真菌感染的种类、部位等。分析乙肝肝衰竭患者合并真菌感染与长期使用多种抗生素、白细胞减少、侵入性操作与检查、人工肝治疗、病情轻重等因素的关系。观察检出真菌对常见抗真菌药物的药物敏感度。结果:876例乙肝肝衰竭患者,合并医院内真菌感染138例,病死率为65.2%(90/138);未合并真菌感染者病死率为50.3%(371/738),前者显著高于后者(P<0.01)。医院内真菌感染未得到控制者病死率为75.9%,明显高于治愈者的病死率(47.1%,P<0.01)。检出真菌中,最常见的是假丝酵母属的白假丝酵母(54.3%)和近平滑假丝酵母(11.6%)。呼吸道和消化道是最常见的感染部位,分别占45.7%和30.4%。检出的138株真菌对两性霉素B的敏感度最高,其次是氟康唑、依曲康唑和酮康唑。138例合并医院内真菌感染者中,长期使用多种抗生素、白细胞减少、接受侵袭性操作者所占比例均高于未合并医院内真菌感染者(P均<0.05),两组接受人工肝治疗者所占比例相近(P>0.05),合并医院内真菌感染患者终末期肝病模型(MELD)评分为(32.4±7.8)分,明显高于未合并医院内真菌感染者的(25.5±6.5)分(P<0.05)。结论:中国南方地区乙肝肝衰竭患者常并发医院内真菌感染。呼吸道与消化道是常见的感染部位。假丝酵母属是主要的感染菌株,感染病原学呈多样性分布。长期使用多种抗生素、白细胞减少、接受侵袭性操作、病情重等是发生医院内真菌感染的高危因素,而人工肝支持治疗并非其高危因素。Objective： To analyze the clinical features of nosocomial mycotic infection in patients with hepatitis B virus-induced liver failure in South China. Methods： Patients with hepatitis B virus-induced liver failure （n = 876） were recruited from Jun 2005 to Jun 2010 in our department. Mortality, category of fungi, position of infection and anti-fungi medicine sensitivity were investigated. Correlations between mycotic infection and clinical parameters, including broad-spectrum antibiotics usage, neutropenia, invasive medical manipulations, severity of liver disease and artificial liver support system （ALSS） treatment, were analyzed. Results： Nosocomial mycotic infection was revealed in 138 patients with liver failure with a mortality of 65.2% （90/138）, significantly higher than those without mycotic infection （50. 3 %, P 〈 0. 01 ）. Mortality of patients with uncontrolled mycotic infection was significantly higher than that of patients with controlled infection （75.9% vs 47.1% , P 〈 0. 01 ）. Candida albicans and Smooth Monilia were detected as most prominent fungal trains （54.3% and 11.6%, respectively）. Meanwhile, respiratory tract and digestive tract were the most common infected sites （45.7% and 30. 4% , respectively）. Amphotericin B, followed with by fluconazol, itraconazole and ketoconazole were proved to be the most sensitive antibiotics in these cases. Except for ALSS treatment, broad-spectrum antibiotic usage, neutropenia and invasive manipulations were revealed as risk factors of fungus infection （P 〈 0. 05 ）. MELD score of patients with mycotic infection was significantly higher than those without mycotic infection （ 32. 4 ± 7. 8 vs 25.5± 6. 5, P 〈 0. 05 ）. Conclusions： Nosocomial mycotic infection, most frequently at respiratory and digestive tracts, is common in patients with hepatitis B virus-induced liver failure in South China. Although Candida mycoderma is revealed as the main infection strains, various pathogens are presented. Except for ALSS, broa

关 键 词：医院内感染 真菌 肝衰竭 病毒性肝炎 乙型 

分 类 号：R519[医药卫生—内科学]