肝衰竭患者并发念珠菌感染的临床特征分析

Clinical characteristics of liver failure complicated by Candida infection

目的 研究肝衰竭患者并发念珠菌感染的临床特征,为临床治疗提供参考。方法 对1985年1月—2011年9月解放军第三〇二医院收治的肝衰竭并发念珠菌感染的393例患者的临床资料进行回顾性研究。结果 393例以中年男性为主,慢加(亚)急性和慢性肝衰竭患者共379例(96.44%),且病毒性肝炎为主要病因,HBV感染所占比例最大,为74.05%。137例并发念珠菌感染前存在细菌感染,腹腔多见(42.06%),致病菌以革兰阴性杆菌为主。念珠菌感染最常见于口咽部,共244例次(43.03%),其次是肺部、消化道等。真菌培养及鉴定结果提示,76.54%为白色念珠菌感染,热带念珠菌及光滑念珠菌所占比例分别为8.64%和4.69%。结论 肝衰竭患者病情危重,并发症多,治疗难度大。尤其是并发念珠菌感染后,多为"二重感染",抗真菌治疗疗效差,患者病死率高。

Objective To investigate the clinical characteristics of patients with liver failure complicated by Candida infections so as to provide evidence for clinical treatment. Methods The clinical data of 393 patients with liver failure complicated by Candida infections, who were treated in 302 Hospital of PLA from Jan. 1985 to Sept. 2011, were retrospectively analyzed. Results Of the 393 pa- tients, middle-aged males accounted for the largest proportion. Totally 379 patients （96.44%） were affected with acute-on-chronic liver failure and chronic liver failure. Viral hepatitis was the main etiology, and HBV infection accounted for the largest proportion （74.05%）. Bacterial infections were found in 137 patients before being complicated by Candida infections, mainly in peritoneal cavity （42.06%） and gram-negative bacilli were the main pathogenic organisms. Candida infections were mainly found in the oropharyngeal region （43.03%）, and then in lungs and digestive tract. Fungal culture results showed that the most common strain was Candida albicans （76.54%）, and next were Candida tropicalis （8.64%） and Candida glabra^a （4.69%）. Conclusions The condition of patients with liver failure is severe and dangerous, often accompanied by complications, and difficult to treat. For patients with liver failure complicated by Candida infec- tions, antifungal treatment has a poor therapeutic efficacy with a high mortality rate.