重型肝炎患者肝移植术后真菌感染临床分析

Clinic analysis of postoperative fungal infection in recipient with severe hepatitis undergoing liver transplantation

目的分析重型肝炎肝移植受体术后真菌感染情况,进一步探讨其易感因素和防治措施。方法回顾性分析我院器官移植中心2003年3月至2006年2月间89例重型肝炎肝移植患者的临床资料并进行讨论。结果89例重型肝炎肝移植患者中21例出现术后真菌感染,感染率为23.6%,较其他病种肝移植更高,其中12例为白念珠菌(57.1%),6例为光滑念珠菌(28.6%),1例为近平滑念珠菌,1例为克柔念珠菌,1例为热带念珠菌。真菌感染多发生在术后1周内,感染部位以呼吸系统为主。结论重型肝炎肝移植患者术后真菌感染以念珠菌属的早期呼吸道感染为主。术前肝性脑病与术后发生真菌感染之间存在相关关系。而一般的白念珠菌感染不会显著地影响重型肝炎肝移植患者的预后。预防性使用抗真菌药物在重型肝炎肝移植术后真菌感染的治疗中具有重要意义。

Objective To analyse the profile of postoperative fungal infection in recipient with severe hepatitis undergoing liver transplantation, and to discuss the risk factors and the methods for prevention and treatment. Methods The clinical data of 89 recipients with severe hepatitis undergoing liver transplantation retrospectively from Mar 2003 to February 2006 was analysed. Results Twenty one patients in the total 89 （23.6%） cases were diagnosed as fungal infection after transplantation. Twelve cases with Candida albicans , 6 cases with Candida glabrata , 1 case with Candida parapsilosis , 1 case with Candida tropicalis , 1 case with Candida krusei. The most common infection site was respiratory system, and was often seen in the first week after transplantation. Conclusion The incidence of postoperation fungal infection in patients with severe hepatitis is higher than that of patients with other disease. In these patients, fungal infections caused by monilia was most common and usually occurred in respiratory system early after transplantation. It should be the correlation between preoperation hepatic encephalopathy and postoperation fungal infections. Severe fungal infection may lead to death of recipients, however, common fungal infection which has been treated appropriately wouldl not significantly influence the patients＇outcome. Prophylactic use of antimycotic agent is very important to the treatment of fungal infection in patients with severe hepatitis undergoing liver transplantation.