肝移植术后肺部真菌感染临床研究

Pulmonary Fungal Infection after Liver Transplantation: Its Clinical Characteristic

目的探讨肝移植术后肺部真菌感染的临床特点、危险因素及病原学特征。方法 收集我院移植中心自 2001年1月-2004年1月,在肝移植术后的救治过程中出现疑似肺部真菌感染的所有病例,留取呼吸道分泌物 标本作真菌直接涂片和(或)真菌培养,用SPSS10.0软件,用单因素条件Logistic回归分析法分析发生肺部真菌 感染的相关临床危险因素。结果205例肝移植患者中,肺部真菌感染发病率为12.2％,感染发生的平均时间为 移植术后(24.3士16.2)d;机械通气时气管插管或气管切开、广谱抗生素过长时间的使用、营养过度包括肠道内营 养和静脉营养、各种导管包括各种血管留置导管、中心静脉导管等及肝移植术前肝肾功能衰竭,均是肝移植术后 发生肺部真菌感染的危险因素;25例患者各种标本共分离出26株念珠菌属,白色念珠菌为57.7％。结论临床 医师应尽量避免给予患者大剂量免疫抑制剂的应用、减少长时间使用广谱抗生素,严格掌握各种侵袭性操作的适 应证,预防肝移植术后各种感染的发生;早期送检各种标本作真菌检测,从而作出早期诊断,提高治愈率。

OBJECTIVE To investigate the incidence, the clinical risk factors and fungal spectrum of pulmonary fungal infection in liver transplantation. METHODS The clinical data, risk factors and culture results of lower respiratory tract specimens were analyzed. RESULTS The incidence of pulmonary fungal infection in liver transplantation was 12. 2%. Logistic analysis showed that mechanical ventilation with incubated tube or with tracheotomy, the duration of adminstration with broad spectrum antibiotics, any kinds of indwelling catheter, excess nutrition and failure of liver and kidney function before liver transplantation were the risk factors of pulmonary fungal infection in patients with liver transplantation. All of the strains isolated from specimens of lower respiratory tract were yeasts. Candida albicans was the most frequent organism isolated which accounted for 57. 7% among all the strains. CONCLUSIONS The incidence of pulmonary fungal infection following liver transplantation appears to have high mortality and morbidity. Clinicians should avoid administrating large dose immunosuppressive agents and long duration of broad spectrum antibiotics and we should focus on enhancing earlier diagnosis, implementing more effective and less toxic anti-fungal therapies.