慢加急性肝衰竭患者侵袭性真菌感染后的临床表现及影响因素分析

摘要/Abstract

摘要： 目的分析慢加急性肝衰竭(ACLF)患者侵袭性真菌感染(IFI)后的临床表现及影响因素。方法回顾性分析2017年1月—2019年1月收治ACLF患者136例(男性107例、女性29例),年龄(51.9±7.7)岁。ACLF符合《肝衰竭诊疗指南(2012年版)》诊断要求。IFI符合《重症患者侵袭性真菌感染诊断与治疗指南(2007)》诊断要求。计量资料以$\bar{x}$±s或M(P₂₅,P₇₅)表示,采用t检验或Kruskal-Wallis H检验进行比较;计数资料以率表示,采用卡方检验进行比较。结果 ACLF病因包括乙型肝炎病毒感染78例(57.3%)、酒精性因素11例(8.1%)、药物性因素28例(20.6%) 、自身免疫性因素12例(8.8%)及其他因素7例(5.1%)。患者糖尿病40例(29.4%)、血液透析46例(33.8%)、抗菌药物使用史61例(44.9%)及侵袭性治疗或操作54例(39.7%)。ACLF患者中IFI 62例,为IFI组;余下为非IFI组(74例),两组患者中糖尿病、血液透析、抗菌药物使用史、侵袭性治疗或操作及死亡例数之间差异有统计学意义(P<0.05)。ACLF患者存活70例,为存活组;死亡66例,为存活组,两组患者中血液透析、侵袭性治疗或操作、MELD评分及IFI例数之间差异有统计学意义(P<0.05)。结论 ACLF患者合并IFI预后较差,患者需注意血糖控制、合理使用抗菌药物、减少或避免侵袭性治疗或操作。

关键词: 慢加急性肝衰竭, 侵袭性真菌感染, 糖尿病, 血液透析

Abstract: Objective To analyze the clinical manifestations and influencing factors of invasive fungal infection (IFI) in patients with chronic and acute liver failure (ACLF). Methods From January 2017 to January 2019, 136 patients with ACLF (male 107 and female 29, 51.9 ±7.7 years old) were reviewed. ACLF meets the diagnostic requirements of the guidelines for diagnosis and treatment of liver failure (2012 edition). IFI meets the diagnostic requirements of "guidelines for diagnosis and treatment of invasive fungal infections in critically ill patients (2007)". The measurement data are expressed as (x?±s) or [M (P₂₅ ~ P₇₅)], t-test or Kruskal-Wallis H test comparison; count data are expressed as (%), chi-square test comparison. Results The causes of ACLF included hepatitis B virus infection in 78 cases (57.3%), alcoholic factors in 11 cases (8.1%), drug factors in 28 cases (20.6%), autoimmune factors in 12 cases (8.8%) and other factors in 7 cases (5.1%). There were 40 cases of diabetes (29.4%), 46 cases of hemodialysis (33.8%), 61 cases of history of antimicrobial use (44.9%) and 54 cases of invasive treatment or operation (39.7%). There were 62 patients with IFI in ACLF group and 74 patients in non-IFI group. There were significant differences in diabetes, hemodialysis, history of antimicrobial use, invasive treatment or operation and death between the two groups. 70 patients with ACLF survived as the survival group, and 66 patients died as the survival group. There were significant differences in hemodialysis, invasive treatment or operation, MELD score and the number of IFI cases between the two groups. Conclusion The prognosis of ACLF patients with IFI is poor. Patients should pay attention to blood glucose control, rational use of antibiotics, reduce or avoid the number of invasive treatment or operation.

Key words: Acute-on-chronic liver failure, Invasive fungal infections, Diabetes, Hemodialysis

戴婧, 祝存奎, 孙秀媛. 慢加急性肝衰竭患者侵袭性真菌感染后的临床表现及影响因素分析[J]. 肝脏, 2020, 25(10): 1098-1100.

DAI Jing, ZHU Cun-kui, SUN Xiu-yuan. Analysis of clinical manifestations and influencing factors of invasive fungal infection in patients with chronic and acute liver failure[J]. Chinese Hepatolgy, 2020, 25(10): 1098-1100.

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