乙型肝炎相关慢加急性肝衰竭患者医院侵袭性肺真菌病的临床研究

Clinical study on nosocomial invasive pulmonary mycosis in patients with hepatitis B virus-related acute-on-chronic liver failure

目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者医院侵袭性肺真菌病的临床特征及相关危险因素。方法收集2013年11月—2019年8月某院收治的HBV-ACLF住院患者临床资料,按是否发生医院侵袭性肺真菌病分成HBV-ACLF医院侵袭性肺真菌病组(研究组)和HBV-ACLF非医院侵袭性肺真菌病组(对照组),分析患者医院侵袭性肺真菌病临床特征、病原菌种类及危险因素。结果共纳入119例患者,其中研究组50例,对照组69例。研究组50例患者均有咳嗽、咳痰,29例有发热,12例有明显胸闷、气促及低氧血症,28例肺部听诊可闻及湿啰音;50例患者胸部CT示肺均有不同程度的改变,血清1-3-β-D葡聚糖抗原检测、半乳甘露聚糖抗原检测阳性率分别为72.00%、36.00%。共分离真菌30株,最常见的真菌为白假丝酵母菌(43.33%)、曲霉菌属(33.33%),28天病死率为76.00%。长期使用广谱抗菌药物、中性粒细胞绝对计数减少、接受侵袭性操作、28天死亡患者数所占比例以及总胆红素水平、国际标准化比值、终末期肝病模型评分、住院时间研究组患者均高于对照组患者(均P<0.05)。结论HBV-ACLF医院侵袭性肺真菌病患者临床表现无明显特异性,主要感染真菌为假丝酵母菌属,与长期使用广谱抗菌药物、中性粒细胞绝对计数减少、接受侵袭性操作等相关,预后差。

Objective To explore the clinical characteristics and risk factors of nosocomial invasive pulmonary mycosis(IPM)in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods Clinical data of HBV-ACLF patients who were admitted to a hospital between November 2013 and August 2019 were collected,according to whether patients had IPM,they were divided into HBV-ACLF nosocomial IPM group(study group)and HBV-ACLF non-nosocomial IPM group(control group),clinical characteristics,pathogenic bacteria and risk factors of nosocomial IPM were analyzed.Results A total of 119 patients were included in study,50 in study group and 69 in control group.In study group,50 patients all had cough and expectoration,29 had fever,12 had obvious chest tightness,shortness of breath and hypoxemia,28 had moist rales through lung auscultation;chest CT of 50 patients showed changes in different degrees,positive rates of serum 1-3-β-D-glucan antigen and galactomannan antigen were 72.00%and 36.00%respectively.A total of 30 strains of fungi were isolated,the most common fungi were Candida albicans(43.33%)and Aspergillus spp.(33.33%),the 28-day mortality was 76.00%.Long-term use of broad-spectrum antimicrobial agents,decrease of absolute neutrophil count,invasive procedure,proportion of 28-day mortality,total bilirubin level,international standardized ratio,score in model for end-stage liver disease,and length of hospital stay in study group were all higher than those in control group(all P<0.05).Conclusion Clinical manifestations of HBV-ACLF patients with nosocomial IPM have no obvious specificity,the main infection fungus is Candida spp.,which is related to the long-term use of broad-spectrum antimicrobial agents,decrease of absolute neutrophil count and invasive procedure,prognosis is poor.