胆道真菌感染91例患者的病原特点及预后分析  

Pathogenic distribution of biliary fungal infection and risk factors of case fatality

作　　者：赵巧素[1] 邬丽娜[1] 叶桦[1] 宋毓飞[1] Zhao Qiaosu;Wu Lina;Ye Hua;Song Yufei(Department of Gastroenterology,Ningbo Medical Center Li Huili Hospital,Ningbo 315400,China)

机构地区：[1]宁波市医疗中心李惠利医院消化内科,315000

出　　处：《中华全科医师杂志》2021年第10期1066-1071,共6页Chinese Journal of General Practitioners

基　　金：公益技术研究计划/社会发展(LGF19H030008,LGF19H030006);宁波市公益技术应用研究计划项目(2019C50100)。

摘　　要：目的了解胆道真菌感染及真菌、细菌混合感染患者的病原学特点及死亡危险因素。方法回顾性分析2013年1月至2019年6月宁波市医疗中心李惠利医院诊治的91例胆道真菌感染患者资料。91例胆汁真菌培养均阳性,其中胆道真菌感染14例,真菌、细菌混合感染77例(84.6%)。进行胆汁真菌病原学分析;结合临床资料,分析一般情况,实验室指标,术前广谱抗生素、激素或免疫抑制剂使用情况,既往有胆道操作史,急性胆道感染病因,手术或操作情况,采用logistic回归分析胆道真菌感染及真菌、细菌混合感染的死亡危险因素。结果91例中,白假丝酵母菌61例、光滑假丝酵母菌19例、热带假丝酵母菌6例;药敏试验显示真菌对两性霉素B和5-氟尿嘧啶敏感率最高,分别为100.0%(91/91)、97.8%(89/91)。77例合并细菌感染者中,革兰阴性菌最多(34例,44.2%)。91例患者年龄(70.7±12.7)岁,良性疾病66例(72.5%),以胆道结石为主(61例,67.0%)。既往有胆道操作史的患者(60例,65.9%)更容易出现胆道真菌、细菌混合感染(56例;χ^(2)=4.56,P=0.03)。91例中,存活79例,死亡12例。12例死亡患者的白蛋白水平为(28.1±5.2)g/L,明显低于79例存活者的(33.3±5.3)g/L(t=2.77,P=0.01),住院时间[29.5(13.0,42.7)d]长于存活患者[12.0(9.0,18.0)d;Z=-2.37,P=0.02]。多项logistic回归分析显示,有既往胆道操作史(OR=4.46,95%CI:1.06~4.97)和胆道真菌、细菌混合感染(OR=10.20,95%CI:1.48~70.27)是胆道真菌感染患者的死亡危险因素。结论胆道真菌感染以白假丝酵母菌等念珠菌为主,且常合并细菌感染,有既往胆道操作史和胆道真菌、细菌混合感染是胆道真菌感染患者死亡危险因素。Objective To analyze the etiology of biliary fungal infection and risk factors of case fatality.Methods Clinical and laboratory data of 91 biliary fungal infection patients admitted in Li Huili Hospital of Ningbo Medical Center from January 2013 to June 2019 were retrospectively reviewed,including 14 patients(16.4%)with fungal infection and 77 patients(84.6%)with fungal and bacterial mixed infection.There were 79 survivors and 12 deaths,the risk factors of fatality were analyzed by binary Logistic regression analysis.Results The fungal strain Candida albicans was detected in 61 cases,Candida glabrata in 19 cases and Candida tropicalis in 6 cases.Drug sensitivity test showed that the fungal strains were highly sensitivity to amphotericin B and 5-fluorouracil[100.0%(91/91),97.8%(89/91)].In 77 mixed infection cases Gram-negative bacteria was the more common(34 cases,44.2%).The average age of patients was 70.7 years old.Benign diseases were found in 66 cases(72.5%)and 61(67.0%)of them were cholelithiasis.Patients with a history of repeated biliary operation were more likely to have mixed infection of biliary fungi and bacteria(χ^(2)=4.56,P=0.03).The mean albumin level in the fatal group was significantly lower than that in the survival group[(28.1±5.2)g/L vs.(33.3±5.3)g/L;t=2.77,P=0.01].The median length of hospital stay in the survival group was significantly shorter than that in the fatal group[12.0(9.0,18.0)d vs.29.5(13.0,42.7)d;Z=-2.37,P=0.02].Multiple logistic regression analysis showed that the history of repeated biliary operation(OR=4.46,95%CI:1.06—4.97)and mixed infection of fungi with bacteria(OR=10.20,95%CI:1.48—70.27)were the risk factors of case fatality.Conclusion Candida albicans is the main fungus in biliary fugal infection which is often complicated with bacterial infection.Repeated biliary operations and mixed infection of fungi with bacteria are the risk factors of death in patients with biliary infection.

关 键 词：胆管炎 胆道念珠菌 侵袭性真菌感染 病原学 危险因素 

分 类 号：R575.7[医药卫生—消化系统]