102例终末期肝病患者并发侵袭性真菌感染的诊断、治疗研究

发布时间：2018-12-15 23:17

【摘要】：目的:了解终末期肝病患者并发侵袭性真菌感染的情况、临床特点及抗真菌治疗的效果,以期取得更好的疗效,改善临床预后。方法:回顾性分析102例终末期肝病并发侵袭性真菌感染的诱因、临床表现、血常规、G试验、影像学特征、真菌学特点、抗真菌治疗时机和疗效,观察氟康唑、伏立康唑和卡泊芬净抗真菌的疗效。结果:102例患者中确诊28例,临床诊断29例,拟诊45例。其中腹部感染50例,肺部37例,血流8例,中枢4例,腹部肺部同时感染3例。均用过1~2个疗程的广谱抗菌药物,部分患者长期使用糖皮质激素。治疗前G试验阳性患者82例。102例患者中58例口腔肉眼可见毛状白斑,涂片发现真菌。外周血白细胞计数大于10×10~9个/L者58例(56.9%),中性粒细胞分类大于80%的79例(77.5%);29例患者CT发现肺部病变。氟康唑治疗17例,治愈10例(58.8%),无效7例;伏立康唑治疗23例,治愈15例(65.2%),无效8例;卡泊芬净治疗58例,治愈46例(79.3%),无效12例,治愈率以卡泊芬净组为高,但无统计学差异。结论:终末期肝病有高危因素存在,易并发侵袭性真菌感染,主要病原菌为念珠菌。但临床症状体征无特异性,易漏诊,治疗时间越早,疗效越好。卡泊芬净治疗终末期肝病伴发的侵袭性真菌感染疗效高、安全性好,适合临床应用。
[Abstract]:Objective: to investigate the status, clinical characteristics and antifungal effect of invasive fungal infection in patients with end-stage liver disease in order to obtain better curative effect and improve clinical prognosis. Methods: the inducement, clinical manifestation, blood routine test, G test, imaging features, mycological characteristics, antifungal treatment time and efficacy of 102 cases of end-stage liver disease complicated with invasive fungal infection were retrospectively analyzed. Effect of Volconazole and Carpofen on antifungal activity. Results: of 102 patients, 28 were diagnosed, 29 were clinically diagnosed and 45 were expected to be diagnosed. There were 50 cases of abdominal infection, 37 cases of lung, 8 cases of blood flow, 4 cases of central nervous system, 3 cases of simultaneous infection of abdomen and lung. All patients were treated with 1 ~ 2 courses of broad-spectrum antimicrobial agents, and some patients were treated with glucocorticoid for a long time. Before treatment, 82 patients were positive for G test, 58 of 102 patients were found to have trichoid leukoplakia in the oral cavity and fungi were found in smears. The peripheral blood leukocyte count was more than 10 脳 10 ~ 9 / L in 58 cases (56.9%), and the neutrophil classification was more than 80% in 79 cases (77.5%). Pulmonary lesions were found in 29 patients with CT. Of the 17 cases treated with fluconazole, 10 cases (58.8%) were cured, 7 cases were ineffective, 23 cases were cured, 15 cases (65.2%) were cured and 8 cases were ineffective. Of 58 cases treated with carpofen, 46 cases (79.3%) were cured and 12 cases were ineffective. The cure rate of carpofen group was higher than that of carpofen group, but there was no statistical difference. Conclusion: there are high risk factors in end-stage liver disease, which are susceptible to invasive fungal infection and the main pathogen is Candida. But the clinical symptoms and signs are not specific, easy to miss diagnosis, the earlier the treatment time, the better the curative effect. Carpofen is effective and safe in the treatment of invasive fungal infection associated with end-stage liver disease.
【作者单位】：成都中医药大学临床医学院;重庆医科大学附属第二医院感染病科;
【基金】：国家自然科学基金资助项目(编号:81171563)
【分类号】：R519;R575

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