慢性重型肝炎合并肠道真菌感染的临床分析42例

Clinical analysis of 42 patients with chronic severe hepatitis complicated with intestinal fungal infection

目的:探讨慢性重型肝炎合并肠道真菌感染的临床特点、易感因素及防治措施.方法:对2010-04/2014-07福建医科大学附属南平市第一医院收治98例慢性重型肝炎患者进行回顾性研究,设合并肠道真菌感染组(42例)、无肠道真菌感染对照组(56例);本文通过分析肠道真菌感染的菌群和构成比对可能导致肠道真菌感染的因素进行单因素分析和Logistic回归模型分析.结果:(1)慢性重型肝炎并发肠道真菌感染以白色假丝酵母菌为主(43.75%);(2)感染组与对照组单因素分析发现:抗菌素使用时间,自发性腹膜炎,门静脉高压症,住院天数>30 d低白蛋白血症及白细胞计数<4.0×109/L是慢性重型肝炎并发肠道真菌感染的相关因素(P<0.05);(3)Logistic回归分析发现抗菌素使用时间(OR=3.410)、脾亢后低白细胞血症(OR=3.018)、门静脉高压症(OR=2.357)、低白蛋白血症(OR=2.161)是肠道真菌感染增加的高危因素;(4)感染组患者2 mo内病死率为33.33%(14/42),明显高于对照组病死率16.07%(9/56),两者差异具有统计学意义(P=0.023).结论:慢性重型肝炎并发肠道真菌感染以白色假丝酵母菌为主,且病死率高,积极防治各种高危因素,尽可能早诊断、早治疗.

AIM： To investigate the clinical features, risk factors and preventive measures for chronic severe hepatitis complicated with intestinal fungal infection.METHODS： Ninety-eight patients with chronic severe hepatitis treated from April 2010 to July 2014 at the First Hospital of Fujian Medical University were retrospectively studied, including 42 cases with fungal infection and 56 cases without. The constituent ratios of the species of fungi causing intestinal infections were analyzed. Univariate and multivariate analyses were used to identify the risk factors for intestinal fungal infection in patients with chronic severe hepatitis.RESULTS： Intestinal fungal infection in patients with chronic severe hepatitis was mainly caused by Candida albicans（43.75%）. Univariate analysis indicated that duration of antibiotic use, spontaneous bacterial peritonitis, portal hypertension, length of hospital stay 30 d, hypoalbuminemia and white blood cell count（WBC） 4.0 × 10^9/L were risk factors for intestinal fungal infection in patients with chronic severe hepatitis（P〈0.05）. Multivariate logistic regression analysis showed that duration of antibiotic use（OR = 3.410）, leucopenia（OR = 3.018）, portal hypertension（OR = 2.357） and hypoalbuminemia（OR = 2.161） were independent risk factors（P〈0.05）. The mortality rate was significantly higher in infected patients than in non-infected patients [33.33%（14/42） vs 16.07%（9/56）, P = 0.023]. CONCLUSION： Intestinal fungal infection in patients with chronic severe hepatitis is mainly caused by Candida albicans, and is associated with a high mortality rate. Duration of antibiotic use, leucopenia, portal hypertension and hypoalbuminemia are independent risk factors for intestinal fungal infection in patients with chronic severe hepatitis.