原位肝移植术后48例次真菌感染的诊治体会

Diagnosis and treatment of fungal infection after orthotopic liver transplantation:a report of 48 occurrences

目的探讨原位肝移植术后真菌感染的诊断及治疗方法。方法回顾性分析147例肝移植受体术后发生真菌感染的诊治情况。结果147例患者中,29例发现真菌感染48例次,感染率为19.73%(29/147)。感染好发的部位依次为肺(33.34%,16/48),肠道(22.92%,11/48),泌尿系统(20.83%,10/48)。其中白色念珠菌感染占52.08%,光滑念珠菌感染占22.92%,热带念珠菌感染占12.50%,曲霉菌感染占8.34%,毛霉菌感染占4.17%。氟康唑治疗有效者占41.38%,伊曲康唑治疗有效者占27.59%,科赛斯治疗有效者13.79%,24例感染患者治愈,总有效率为82.76%。5例死亡,病死率17.24%。结论肝移植术后真菌感染的发生率较高,依据影像学检查和病原学检查等可早期诊断真菌感染,及时选用氟康唑、伊曲康唑及科赛斯等早期治疗是治愈真菌感染的关键。

Objective To investigate the diagnosis and treatment method of fungal infection after orthotopic liver transplantation （OLT）. Methods A retrospective survey of 29 fungal infection patients in 147 patients who underwent liver transplantation was made. Results Twenty-nine patients （19. 73% ） had 48 occurrences of invasive fungal infection. Lung fungal infection was found in 16 cases （33.34 % ） , intestine in 11 cases （22.92% ） , and genitourinary system in 10 cases （20.83 % ）. Pathogens were Candida albicans （52.08%） , Candida tropicalis （12.50%） , Aspergillus（8.34% ） and mold fungus（4. 17% ）. Twelve cases were effectively treated with fluconazole, 8 cases with itraconazole, and 4 cases with caspofungin. 24 cases were cured with the curative rate being 82. 76% , and 5 cases died with the mortality being 17.24%. Conclusions The rate of fungal infection after liver transplantation is high. Imaging and pathogenic studies should be done to early diagnose fungal infection, which could be timely treated with effective antifungal agents, such as fluconazole, itraconazole and caspofungin