不同真菌感染对肝衰竭患者病情及预后的影响

目的研究不同真菌感染对肝衰竭患者病情及预后的影响。方法总结肝衰竭合并不同真菌感染患者的临床资料,分析后者对患者病情和转归的影响。结果在资料完整的200例患者中,亚急性肝衰竭3例,慢加急性肝衰竭92例,慢性肝衰竭105例。其中浅部真菌感染39例,侵袭性念珠菌感染89例,侵袭性曲霉菌感染72例。感染前三组患者的终末期肝病模型（MELD）评分分别为25.3±6.0、25.1±6.4和26.2±6.2（P〉0.05）,感染后则分别为25.8±8.7、28.7±9.8和32.9±7.7（P〈0.05）。MELD评分分别增加0.46、3.66和6.75,感染后三组间MELD评分比较,有显著性统计学差异（P=0.000）。浅部真菌感染出院时生存18例（46.1%）,死亡21例（53.9%）,侵袭性念珠菌感染生存34例（38.2%）,死亡55例（61.8%）,侵袭性曲霉菌感染生存11例（15.3%）,死亡61例（84.7%）,三组间病死率比较,差异显著（P〈0.05）。结论侵袭性曲霉菌感染对肝衰竭患者病情恶化的影响最明显,其次是侵袭性念珠菌感染,浅部真菌感染影响较小。

Impacts of different fungous infections on severity and prognosis of patients with liver failure

Objective To study the impacts of different fungous infections on severity and prognosis of patients with liver failure. Methods The clinical data of patients with liver failure complicated by different fungous infections were summarized and the influences of different infections on patients＇severity and outcomes were analyzed. Results 200 patients including 3 with subacute liver failure,92 with acute on chronic liver failure and 105 with chronic liver failure were enrolled in this study. There were 39 superficial fungous infections,89 invasive candida infections and 72 invasive aspergillus infections. The mean model of end-stage liver disease score in the three groups before fungous infection were 25.3±6.0,25.1±6.4 and 26.2±6.2,respectively （P〉0.05）. And the mean MELD were 25.8±8.7,28.7±9.8 and 32.9±7.7,respectively after infection （P〈0.05）. The mortality was 53.9% in superficial fungous infection group,61.8% in invasive candida group,and 84.7% in invasive aspergillus infection （P〈0.05）. Conclusion Patients with liver failure deteriorate after invasive aspergillus infection. Invasive eandida infection also worsens the outcomes of patients with liver failure.