肝硬化失代偿期患者合并侵袭性肺部真菌感染的临床特点及其危险因素分析  

Clinical characteristics and risk factors of invasive pulmonary fungal infection in patients with decompensated liver cirrhosis

作　　者：袁晓霞 陈勇[1] 高淑林[1] 常彩芳[1] Yuan Xiaoxia;Chen Yong;Gao Shulin;Chang Caifang(Department of International Medical,the First Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院国际医疗部,河北张家口075000

出　　处：《中国医学前沿杂志（电子版）》2021年第5期74-78,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：河北省2020年度医学科学研究课题(20200517)。

摘　　要：目的分析肝硬化失代偿期患者并发侵袭性肺部真菌感染(invasive pulmonary fungal infection,IPFI)的临床特点及其危险因素。方法选取2015年1月至2020年2月河北北方学院附属第一医院收治的39例肝硬化失代偿期合并IPFI患者纳入观察组。采用简单随机抽样法选取同期该院收治的50例未合并IPFI的肝硬化失代偿期患者纳入对照组。比较两组患者的临床资料,采用多因素Logistic回归分析探讨肝硬化失代偿期患者并发IPFI的独立危险因素。结果本研究中IPFI大部分来自医院感染,患者无特异性临床表现,血清学G试验和GM试验阳性率分别为66.7%和38.5%。多数患者CT表现以支气管肺炎样阴影为主。全部患者共分离25株真菌,以酵母菌属为主(68.0%),其中白假丝酵母菌最多见。观察组患者3个月内死亡率显著高于对照组(P<0.05)。两组患者年龄、肝功能Child-Pugh评分、肝性脑病、肝功能衰竭、血中性粒细胞计数减少、长期使用广谱抗菌药物、实施侵入性操作的比例、国际标准化比值、住院天数和血白蛋白水平比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果表明,肝性脑病、肝功能衰竭、实施侵入性操作均为肝硬化失代偿期患者并发IPFI的独立危险因素(均P<0.05)。结论肝硬化失代偿期合并IPFI患者无特异性临床表现,其发生与肝性脑病、肝功能衰竭、实施侵入性操作等因素有关。Objective To analyze the clinical characteristics and risk factors of invasive pulmonary fungal infection(IPFI)in patients with decompensated liver cirrhosis.Method Thirty-nine decompensated liver cirrhosis patients with IPFI admitted in the First Affiliated Hospital of Hebei North University from January 2015 to February 2020 were enrolled for the study as observation group,and 50 decompensated liver cirrhosis patients without IPFI were selected as control group through simple random sampling.The clinical data were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the independent risk factors of IPFI in patients with decompensated cirrhosis.Result Most of IPFI came from hospital infection and had no specific clinical manifestations.The positive rates of serological G test and GM test were 66.7%and 38.5%,respectively.CT findings of most patients were bronchopneumonia like shadow.Twenty-five strains of fungi were isolated from all patients,of which saccharomyces was the main strain(68.0%),and the most common was candida albicans.The mortality rate within 3 months in observation group was significantly higher than that in control group(P<0.05).There were significant differences in age,Child-Pugh score of liver function,hepatic encephalopathy,liver failure,decreased neutrophil count,long-term use of broad-spectrum antibiotics,proportion of invasive operation,international standardized ratio,hospital days and blood albumin level between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that hepatic encephalopathy,liver failure and invasive operation were the independent risk factors of IPFI in patients with liver cirrhosis(all P<0.05).Conclusion There is no specific clinical manifestation in decompensated liver cirrhosis patients with IPFI.Its occurrence is related to hepatic encephalopathy,liver failure and invasive operation.

关 键 词：侵袭性肺部真菌感染 肝硬化失代偿期 临床特点 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R575.2[医药卫生—内科学]