肝移植术后真菌感染的特点及其因素分析

发布时间：2018-06-20 06:02

本文选题：肝移植 + 真菌感染　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:探究肝移植术后真菌感染的特点(发生率、时间、部位、类型、耐药规律)及术前原发疾病、肝功能状况、术前并发症对术后真菌感染的影响;为真菌感染的早期诊断提供实验依据,为肝移植患者术后提供预防和治疗真菌感染的临床依据。方法:采用病例-对照研究,回顾性分析江西省人民医院器官移植中心2005年4月-2014年4月期间实施的115例肝移植术患者的临床资料,根据患者症状、体征及影像学检查结果综合分析,并收集相关标本进行真菌培养,明确是否真菌感染及感染类型,根据真菌培养结果将移植术后患者分为两组:感染组(真菌培养阳性),未感染组(真菌培养阴性);对感染组标本再行药敏实验,观察真菌耐药性情况,计量资料以均数±标准差(sx±)表示,组间比较采用t检验;计数资料以率表示,组间比较用c2检验;按a=0.05检验水准,以P0.05具有统计学意义。比较两组病例在肝原发性疾病、术前肝功能情况,术前并发症对术后真菌感染的差异,并分析其原因。结果:1、在行肝移植术患者的原发疾病中,重症肝炎患者术后真菌感染比例为41.6%,非重症肝炎术后真菌感染18.1%,重症肝炎与非重症肝炎患者相比,感染组与未感染组有统计学差异(P0.05),其它原发性肝病患者行肝移植术后,感染组与未感染组进行分析无统计学差异(P0.05)。2、术前肝功能Child-pugh评分与Meld评分,Child C级和Meld评分25分患者中,感染组与未感染组感染情况对比,有统计学差异(P0.05)。3、术前并发症中,发现腹水2000ml,胸水500ml,低白蛋白血症,肝肾综合征,严重贫血5种因素在感染组和未感染组中有统计学差异(P0.05)。4、患者移植手术时间及其真菌感染率:3-5月组移植数30例(30/115,26.08%),感染率为(9/30,30.0%);6-8月组移植数27例(27/115 23.47%),感染率为(3/32,18.51%);9-11月组移植数32例(32/115,27.82%),感染率为(3/32,9.37%);12-2月组移植数26例(26/115,22.60%),感染率为(12/26,46.15%)。不同手术月份分组中感染组与未感染组进行c2检验,计算P=0.01,有统计学差异(P0.05)。5、29例患者有14例首次真菌感染发生在移植手术后4周内,占48.27%,24例患者真菌感染发生在术后8周占82.75%。6、29例发生真菌感染患者总共培养出62株菌株,总共检出7种真菌分别为:白色念珠菌51.6%、曲霉菌16.1%、光滑念珠菌9.6%、烟曲霉菌4.8%、热带念珠菌8.0%、酵母样菌4.8%、近平滑假丝酵母菌8.0%。白色念珠菌发病率最高,痰液是最常见的阳性标本,67.7%的阳性标本是从痰液标本培养获得的,呼吸系统和消化系统是肝移植术后真菌易感部位。7、肝移植术后真菌感染,经微生物学实验共检出62株,7种真菌,以氟康唑及两性霉素B最易耐药,耐药率分别为37.09%、29.03%。结论:1、原发疾病为重症肝炎患者,在肝移植术后易真菌感染;伴有胸腹水、低蛋白血症、肝肾综合征并发症的患者,术后感染真菌概率增高。2、术前进行肝功能Child-pugh与MELD评分,可作为预测肝移植术后真菌感染的依据。评分等级越高或分数越大,患者术后越易发生真菌感染。3、肝移植术后真菌感染一般发生在术后2月以内,以呼吸系统及消化系统感染为主,常见真菌为白色念珠菌。4、术后患者真菌感染时间发生以每年的12月-2月居多,感染与气候有关。5、减少氟康唑及两性霉素B用药频率,降低真菌耐药率。
[Abstract]:Objective: To explore the characteristics of fungal infection after liver transplantation (incidence, time, location, type, drug resistance) and pre operation disease, liver function and the effect of preoperative complications on postoperative fungal infection, provide experimental basis for early diagnosis of fungal infection, and provide a clinical basis for the prevention and treatment of fungal infection after liver transplantation. Methods: a case-control study was used to review the clinical data of 115 patients with liver transplantation during the April -2014 year of April 2005 in the Jiangxi People's Hospital organ transplantation center, to analyze the symptoms, signs and imaging findings of the patients, and to collect the related specimens for fungal culture and to identify the fungal infection and the sense of infection. After the fungal culture, the patients were divided into two groups: infection group (fungal culture positive), uninfected group (negative fungus culture), drug sensitivity test of the infection group, observation of fungal resistance, measurement data with mean standard deviation (SX +), t test in groups, rate of count data, and among groups Compared with C2 test, according to a=0.05 test level, P0.05 had statistical significance, compared two groups of cases in primary liver disease, preoperative liver function, preoperative complications of postoperative fungal infection, and analysis of the causes. Results: 1, in the primary disease of patients with liver transplantation, the proportion of postoperative fungal infection in severe hepatitis patients was 41.6%. There was a statistical difference between the infection group and the uninfected group (P0.05). There was no statistical difference between the infection group and the uninfected group (P0.05).2 after the liver transplantation (P0.05).2, and the preoperative liver function score and Meld score, Child C grade. Among the patients with the Meld score of 25, the infection group was compared with the uninfected group, and there was a statistical difference (P0.05).3. In the preoperative complications, the 5 factors of ascites, 2000ml, 500ml, hypoalbuminemia, hepatorenal syndrome, and severe anemia were statistically different (P0.05).4, and the time and true of the transplant operation were true. Bacterial infection rate: 3-5 months group transplantation number (30/115,26.08%), infection rate (9/30,30.0%); 6-8 months group transplantation number (27/115 23.47%), infection rate (3/32,18.51%); 9-11 month group 32 cases (32/115,27.82%), infection rate (3/32,9.37%); 12-2 months group transplantation number (26/115,22.60%), infection rate (12/26,46.15%). Different operation months group C2 test was carried out between the middle infection group and the uninfected group, and the P=0.01 was calculated. There was a statistical difference (P0.05). There were 14 cases of first fungal infection in.5,29 cases, which occurred within 4 weeks of the transplant operation, accounting for 48.27%. 24 cases of fungal infection occurred in 8 weeks after the operation and 62 strains were cultivated in 82.75%.6,29 cases, and 7 fungi were detected in total. Not as: Candida albicans 51.6%, Aspergillus 16.1%, Candida albicans 9.6%, Aspergillus fumigatus 4.8%, Candida albicans 8%, yeast like bacteria 4.8%, Candida albicans 8.0%., Candida albicans, sputum are the most common positive specimens, 67.7% positive specimens are obtained from sputum specimens, the respiratory system and digestive system are liver Fungal susceptibility to.7 after transplantation and fungal infection after liver transplantation, 62 strains and 7 fungi were detected by microbiological experiments. Fluconazole and amphotericin B were the most susceptible, the drug resistance rate was 37.09%, respectively, 29.03%. conclusion: 1, the primary disease was severe hepatitis, and the fungal infection was easy after liver transplantation; with thoracic and ascites, hypoproteinemia and hepatorenal syndrome. In patients with complications, the incidence of fungal infection after operation increased by.2. Preoperative liver function Child-pugh and MELD score could be used as a basis for predicting fungal infection after liver transplantation. The higher the grade or the greater the score, the more susceptible to fungal infection after the operation, the more susceptible to fungal infection after the operation. The fungal infection usually occurred within February after the operation, with respiratory system. The main fungi are Candida albicans.4, the common fungi are Candida albicans. The fungal infection time of the patients after the operation is mostly in the year of December -2 months. The infection is associated with the climate related.5, reducing the frequency of fluconazole and amphotericin B, and reducing the rate of fungal resistance.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

【参考文献】