慢性重型肝炎患者侵袭性真菌感染的临床特点及治疗分析

目的：调查慢性重型肝炎（CSH）患者并发侵袭性真菌感染（IFI）的临床特点及抗真菌药物的疗效,以期提高其诊治水平。方法：对79例慢性重型肝炎并发IFI患者的临床表现、血常规、影像学、真菌学特征、抗真菌治疗方案及疗效进行回顾性分析,比较氟康唑与伏立康唑抗真菌的疗效。结果：13例（16.5%）患者较长时间使用糖皮质激素或其他免疫抑制剂,40例（50.6%）患者有侵入性操作史,61例 (77.2 %)使用过1~6种广谱抗生素。73例(92.4%)患者有发热,96.2%的患者白细胞及中性粒细胞增高,感染部位以肺部（31.6%）、肠道（26.2%）和口腔（14%）多见。70.9％患者可查到真菌,以白色念珠菌（40.9％）和曲霉菌（21.1％）为主。40%真菌性肺炎患者肺部CT可表现相对特异性的晕轮征和新月征。伏立康唑治疗IFI有效率明显高于氟康唑（71.4％ vs. 39.0％,P＜0.05）。伏立康唑治疗肺部曲霉菌感染12例,有效8例,死亡4例,有效率66.7％。结论：大多数CSH患者并发IFI有高危因素。感染部位以肺部和肠道常见,菌种以白色念珠菌和曲霉菌最为常见。伏立康唑的疗效好于氟康唑,可提高慢性重型肝炎并发IFI患者的生存率。

Clinical characteristics and therapeutic analysis of invasive fungal infection in chronic severe hepatitis patients

Objective To investigate clinical features and antifungal therapeutic effect of chronic severe hepatitis (CSH) patients with invasive fungal infection (IFI), and to improve the diagnosis and treatment.Methods Clinical manifestation, blood routine, imageology and mycetology characteristic, antifungal treatment perscription and therapeutic effect of 79 CSH patients with IFI were retrospectively analyzed. Antifungal therapeutic effect was compared between fluconazole and voriconazole. Results Thirteen (16.5%) patients received glucocorticoid or other immunodepressants for a relatively long time, 40 (50.6%) patients had invasive operation, and 61 (77.2 %) patients were administered 1-6 kinds of broad-spectrum antibiotics. Seventy-three patients had fever. Leucocytes and neutrophilic granulocyte increased in 96.2% of the patients. Lung (31.6%), intestinal tract (26.2%) and oral cavity (14%) infections were common. Fungus was found in 70.9% of the patients. Candida albicans (40.9%) and aspergillus (21.1%) were often seen. Halo signs and crescent signs on lung CT were relatively specific in 40% of the patients with fungal pneumonia. Voriconazole was more effective than fluconazole(71.4% vs. 39.0%, P<0.05). Twelve patients with lung aspergillus infection were administered voriconazole, 8 (66.7%) patients of whom was effective, and the other 4 (33.3%) patients died. Conclusion There are high risk factors in major CSH patients with IFI. The most common clinical manifestations of CSH patients with IFI are fever, leukocytosis, lung and intestinal tract infection. Candida albicans and aspergillus infection are common. Voriconazole is more effective than fluconazole, and can increase the survival rate of CSH patients with IFI.