HBV-ACLF侵袭性肺真菌感染的临床特征及预后危险因素  

Clinical features and prognostic risk factors of HBV-ACLF invasive pulmonary fungal infection

作　　者：李玄丹 李材忠 唐咏婕 蔡潇阳 王生成 LI Xuandan;LI Caizhong;TANG Yongjie;CAI Xiaoyang;WANG Shengcheng(Respiratory Medicine,Danzhou People's Hospital,Danzhou,Hainan,China,571700;Infectious Dis-ease Department,Danzhou People's Hospital,Danzhou,Hainan,China,571700)

机构地区：[1]儋州市人民医院呼吸内科,海南儋州571700 [2]儋州市人民医院感染科,海南儋州571700

出　　处：《分子诊断与治疗杂志》2022年第8期1399-1402,共4页Journal of Molecular Diagnostics and Therapy

基　　金：海南省自然科学基金面上项目(20168340)。

摘　　要：目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者侵袭性肺真菌感染的临床特征及预后危险因素。方法以2015年1月至2020年1月儋州市人民医院收治的247例HBV-ACLF患者为研究对象,根据患者是否发生侵袭性肺真菌感染分为非感染组(n=184)和感染组(n=63),分析感染组菌株种类,并探讨影响患者发生侵袭性肺真菌感染的危险因素。对感染组患者随访1年,根据是否存活分为存活组和死亡组,探讨影响患者预后的危险因素。结果63例感染患者共分离71株菌株,其中以白色念珠菌为主(45.07%)。多因素Logistic回归分析结果显示,长期使用广谱抗生素、有侵入性操作、MELD评分≥29.14以及TBIL≥334.29μmol/L是影响患者发生侵袭性肺真菌感染的独立危险因素。随访1年,共23例患者死亡。多因素Logistic回归分析结果显示,侵入性操作、MELD评分≥32.06以及TBIL≥471.09μmol/L是影响HBV-ACLF侵袭性肺真菌感染患者死亡的独立危险因素。结论HBV-ACLF侵袭性肺真菌感染患者主要以白色念珠菌感染为主。对于具有侵入性操作、MELD评分、TBIL水平过高的HBV-ACLF侵袭性肺真菌感染患者需及时关注预后。Objective To investigate the clinical features and prognostic risk factors of invasive pulmonary fungal infection in patients with chronic acute liver failure(HBV-ACLF)associated with hepatitis B.Methods A total of 247 HBV-ACLF patients admitted to Danzhou People’s Hospital were selected as the research objects,and they were divided into the non-infection group(n=184)and the infection group(n=63)according to whether the patients had invasive pulmonary fungal infection.The strains of the infection group were analyzed,and the risk factors affecting the occurrence of invasive pulmonary fungal infection were discussed.The patients in the infection group were followed up for 1 year and were divided into a survival group and a death group according to whether they survived or not,to explore the risk factors affecting the prognosis of the patients.Results A total of 71 strains were isolated from 63 infected patients,among which Candida albicans was the main strain(45.07%).Multivariate Logistic regression analysis showed that long-term use of broad-spectrum antibiotics,invasive procedures,MELD score≥29.14 and TBIL≥334.29μmol/L were independent risk factors for invasive pulmonary fungal infection.During the 1-year follow-up,a total of 23 patients died.Multivariate Logistic regression analysis showed that invasive procedures,MELD score≥32.06 and TBIL≥471.09μmol/L were independent risk factors for death in patients with HBV-ACLF invasive pulmonary fungal infection.Conclusion Patients with HBV-ACLF invasive pulmonary fungal infection are mainly infected with Candida albicans.Prognosis should be paid attention to patients with HBV-ACLF invasive pulmonary fungal infection with invasive procedures,MELD score and high TBIL level.

关 键 词：乙型肝炎相关慢加急性肝衰竭 真菌 预后 

分 类 号：R575.3[医药卫生—消化系统] R519[医药卫生—内科学]