102例终末期肝病患者并发侵袭性真菌感染的诊断及治疗研究

发布时间：2018-02-28 10:45

本文关键词： 终末期肝病侵袭性真菌感染氟康唑伏立康唑卡泊芬净　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【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29例(隐球菌4例,念珠菌24例,曲霉菌1例),临床诊断28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。主要临床表现为腹胀、腹水消难以消退、动力性肠梗阻、利尿效果不好、肝功能无改善、甚至恶化。部分患者出现不同程度的咳嗽、气促、呼吸困难和发热。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10×109/L 58例(56.9%),中性粒细胞分类大于80%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 situation, clinical characteristics and antifungal effect of invasive fungal infection in patients with end-stage liver disease. Methods: the causes, clinical manifestations, blood routine G test, imaging features, mycological characteristics, antifungal treatment timing and efficacy of 102 cases of end-stage liver disease complicated with invasive fungal infection were retrospectively analyzed. Results 29 cases (4 cases of Cryptococcus, 24 cases of Candida, 1 case of Aspergillus, 28 cases of clinical diagnosis and 45 cases of planned diagnosis) were confirmed in 102 cases, including 50 cases of abdominal infection, 37 cases of lung, 8 cases of blood flow. There were 4 cases of central nervous system and 3 cases of simultaneous infection of abdomen and lung. All of them were treated with broad-spectrum antimicrobial agents for 1 ~ 2 courses. Some of them used glucocorticoid for a long time. Before treatment, 82 cases were positive for G test. The main clinical manifestations were abdominal distension, ascites elimination was difficult to disappear. Dynamic intestinal obstruction, diuretic effect, no improvement or even deterioration of liver function. Some patients developed cough, shortness of breath, dyspnea and fever in 58 out of 102 patients. The peripheral blood leukocyte count was greater than 10 脳 10 9 / L in 58 cases (56.9%), neutrophil classification was greater than 80 y (77.5%) and 29 cases were found pulmonary lesions on CT. 17 cases were treated with fluconazole, 10 cases were cured, 7 cases were ineffective, 23 cases were treated with fulconazole. Fifteen cases were cured, 8 cases were ineffective, 58 cases were treated with carpofen, 46 cases were cured with 79.3%, 12 cases were ineffective. The cure rate was high in carpofen group, but there was no statistical difference. Conclusion: there are high risk factors for end-stage liver disease and are prone to complicated with invasive fungal infection. Candida is the main pathogen, but the clinical symptoms and signs are not specific, easy to miss diagnosis, the earlier the treatment time, the better the curative effect. Carbofen Jing treatment of invasive fungal infection associated with end-stage liver disease has high efficacy, good safety, and is suitable for clinical application.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519;R575

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