人工肝支持系统治疗后HBV-ACLF患者侵袭性真菌感染的发生情况、临床特征及转归分析

摘要/Abstract

摘要： 目的分析人工肝支持系统治疗后HBV相关慢加急性肝衰竭(HBV-ACLF)患者侵袭性真菌感染的发生情况、临床特征及转归。方法选取2018年10月至2024年1月南通市第三人民医院收治的接受人工肝支持系统治疗的HBV-ACLF患者50例,依据真菌感染与否分为发生组(n=25)和未发生组(n=25),并作临床资料比较。另根据随访1年后是否存活将发生组分为生存组(n=16)和死亡组(n=9),对两组一般资料进行单因素分析,并运用多因素logistic回归分析探讨人工肝支持系统治疗后HBV-ACLF患者侵袭性真菌感染预后的危险因素。结果发生组平均住院天数为(68.0±4.7)d高于未发生组[(34.6±6.8)d],肝硬化、糖尿病病史人数占比分别为32.0%、44.0%,均高于未发生组(8.0%、16.0%),发生组白蛋白、总胆红素、白细胞计数、终末期肝病模型评分分别为(31.2±4.5)g/L、(314.2±101.3)μmol/L、(12.7±1.8)×10⁹/L、(26.1±2.6)分,与未发生组比[(34.8±4.9)g/L、(212.5±101.6)μmol/L、(10.6±0.2)×10⁹/L、(22.9±1.8)分],差异有统计学意义(P<0.05)。死亡组住院天数、白蛋白、总胆红素水平以及白细胞计数分别为(94.6±5.8)d、(29.1±4.0)g/L、(412.5±121.6)μmol/L、(13.6±2.2)×10⁹/L,生存组为[(60.3±4.2)d、(33.2±4.3)g/L、(118.2±2.3)μmol/L、(5.6±2.5)×10⁹/L,P<0.05,两组比较差异有统计学意义。多因素logistic回归分析结果显示,住院天数、白蛋白、总胆红素水平以及白细胞计数是人工肝支持系统治疗后HBV-ACLF患者侵袭性真菌感染的独立危险因素(OR=5.217、4.928、5.063、4.923,P<0.05)。结论人工肝支持系统治疗后HBV-ACLF患者好发侵袭性真菌感染,病情发展快速,死亡率较高,HBV-ACLF患者侵袭性真菌感染预后与住院天数、白蛋白、总胆红素水平以及白细胞计数有关。

关键词: 人工肝支持系统, 乙型肝炎病毒, 慢加急性肝衰竭, 侵袭性真菌感染, 临床特征, 转归

Abstract: Objective To analyze the incidence, clinical characteristics and prognosis of invasive fungal infection in patients with HBV-ACLF after artificial liver support system treatment. Methods Fifty patients with HBV-ACLF treated with artificial liver support system admitted to our hospital between October 2018 and January 2024 were divided into occurrence group (n=25) and non-occurrence group (n=25) according to whether fungal infection occurred or not. The two groups were compared in terms of clinical characteristics, glucocorticoid treatment regression analysis, and multi-factor logistic regression was used to analyze independent risk factors for invasive fungal infections in patients with HBV-ACLF after treatment with artificial liver support system. Results The mean number of hospital days and duration of treatment was (68.0±4.7) d in the occurrence group, respectively, which was higher than in the non-occurrence group [(34.6±6.8) d, P<0.05], The number of people with a history of cirrhosis and diabetes was 32.0% and 44.0%, respectively, which were higher than those in the no-incidence group (8.0% and 16.0%, respectively, P<0.05). The albumin, total bilirubin, white blood cell count and model score of end-stage liver disease in the occurrence group were (31.2±4.5) g/L, (314.2±101.3) μmol/L, (12.7±1.8) ×10⁹/L, and (26.1±2.6), respectively, which were significantly different from the non-occurrence group [(34.8±4.9) g/L, (212.5±101.6) μmol/L, (10.6±0.2) × 10⁹/L, and (22.9±1.8) points], P<0.05. The number of hospital days, albumin, total bilirubin level, and white blood cell count in the death group were (94.6±5.8) d, (29.1±4.0) g/L, (412.5±121.6) μmol/L and (13.6±2.2) × 10⁹/L, which were different from the survival group [(60.3±4.2) d, (33.2±4.3) g/L, (118.2±2.3) μmol/L, and (5.6±2.5) × 10⁹/L, respectively, P<0.05]. Multifactorial logistic regression analysis showed that days of hospitalization, albumin, total bilirubin level and white blood cell count were independent risk factors for invasive fungal infections in patients with HBV-ACLF after treatment with an artificial liver support system (OR=5.217, 4.928, 5.063, 4.923, P<0.05). Conclusion The prognosis of invasive fungal infection in HBV-ACLF patients is related to the number of days in hospital, albumin, total bilirubin level, and white blood cell count after treatment with artificial liver support system.

Key words: Artificial liver, Hepatitis B virus, Acute-on-chronic liver failure, Invasive fungal infection, Clinical features, Regression

朱晓红, 王娟, 黄左宇. 人工肝支持系统治疗后HBV-ACLF患者侵袭性真菌感染的发生情况、临床特征及转归分析[J]. 肝脏, 2025, 30(11): 1525-1528.

ZHU Xiao-hong, WANG Juan, HUANG Zuo-yu. Analysis of the occurrence, clinical characteristics and regression of invasive fungal infections in patients with HBV-ACLF after treatment with an artificial liver support system[J]. Chinese Hepatolgy, 2025, 30(11): 1525-1528.

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