肝硬化腹水真菌感染18例的临床研究

Clinical Research about 18 Cases of Cirrhosis Ascites Due to Fungous Infection

目的了解肝硬化腹水真菌感染的临床特点及有效防治措施。方法采取回顾性调查方法，分析患者的一般情况、实验室检查、肝硬化腹水真菌感染相关因素和抗真菌治疗及转归。结果18例患者临床表现腹胀，腹部压迫柔韧感，压痛反跳痛不明显，伴或不伴发热，体温在（38．5±1．5）℃，血WBC计数较感染前上升，腹水常规呈感染征象，治疗均采用氟康唑200mg，每日1次静脉推注或静脉滴注，并隔日腹腔内注射200mg抗真菌治疗，治愈3例，11例经济困难自动出院。死亡4例。对11例出院患者随访得知均于不久后去逝。病原学检查证明，全部为条件致病性真菌感染，除感染曲霉菌2例和酵母菌1例外，其余均为白色念珠菌。结论肝硬化腹水真菌感染表现不典型，治疗困难，预后极差，应采取措施积极预防真菌感染。

Objective To understand clinical features and effective prevention for cirrhosis ascites due to fungous infection. Methods Retrospective survey methodology was used to analyze patients with normal circumstances,laboratory tests, related factors of cirrhosis ascites due to fungous infection, and anti-fungal treatment and prognosis. Results Eighteen patients were involved in, and they had clinical manifestations of abdominal distension ,abdominal flexible sense of oppression, no obvious anti-tenderness, with or without fever, body temperature at （38.5 ± 1.5 ） ℃, increased WBC counts, and infection signs at conventional ascites. After treatment with 200 mg fluconazole, by intravenous injection or intravenous drip once daily and 200 mg anti-fungal medicine by intra-abdominal injection every three days,3 cases were cured, 11 cases had automaticdischarge for economic difficulty ,and 4 cases died. After follow-up 11 cases of patients discharged from hospital ,they all died soon. By etiological examination ,all of them belonged to pathogenic fungal infections. To be more exact, most of the pathogenic fungal were Candida albicans, except two aspergillus strains and one yeast strain. Conclusion Cirrhosis ascites accompanied by fungal infection has not typical performance, and it is difficult for treatment with poor prognosis. Active measures should be suggested to prevent fungal infections for cirrhosi patients.