84例老年肝衰竭患者合并真菌感染的临床特征

Clinical Characteristics of Liver Failure with Fungal Infections in Elderly Patients: Analysis of 84 Cases

目的了解老年肝衰竭患者合并真菌感染的临床特征及预后影响因素。方法将1986年以来84例老年肝衰竭并发真菌感染的患者,按病情转归分为有效组和无效组。结果真菌感染菌属主要为白色假丝酵母菌(58.33%)、烟曲霉菌(9.52%)、热带假丝酵母菌(8.33%);主要感染部位为肺部(43.88%)、口咽部(32.65%)、肠道(9.18%)、血液(5.10%)等;治疗转归:有效35例(41.67%),无效49例(58.33%);治疗无效的危险因素包括:老年患者、合并多器官功能障碍、曲霉菌属感染等;多因素分析发现:是否合并多器官功能障碍是判断此类患者病情转归的重要指标。结论对于老年肝衰竭患者,积极预防感染,加强肝脏原发病的治疗,注意心、脑、肺、肾等脏器的监测和维护,早期合理使用抗真菌药物,是改善老年肝衰竭及合并真菌感染患者预后的重要措施。

OBJECTIVE To study clinical characteristics of liver failure with fungal infections in the elderly patients and risk factors associated with treatment failure. METHODS Eighty four elderly patients with liver failure followed by fungal infections since 1986 were divided into two groups： effective group and ineffective group. RESULTS The common pathogens were Candida albicans （58.33 %）, Aspergillus fumigatus （9.52 %） and Candida tropicalis（8.33%）. The lungs （43.88%）, mouth （32.65%）, intestinal tract （9.18%） and blood（5.10%%） were the main sites of fungal infection. Among them after treatment, 35 cases （41.67%） were effective compared with 49 cases （58. 33%） ineffective. The risk factors for treatment failure included age, complication with multiple organ dysfunction syndrome （MODS） and aspergillosis. In multivariate analysis, we found MODS in patients was an independent factor in predicting the prognosis. CONCLUSIONS To improve the treatment outcome, important measures include preventing infection, enhancing the treatment of liver failure, monitoring and supporting multiple organs： heart, brain, lungs and kidneys, and promptly rational administration of antifungal agents in elderly patient with liver failure.