肝衰竭患者侵袭性肺曲霉病的临床特点及治疗分析

目的提高对肝衰竭患者并发侵袭性肺曲霉病（invasive pulmonary aspergillosis IPA）的认识，探讨其临床特点及其对策。方法回顾性分析2005年11月至2007年9月间收治的341例肝功能衰竭并发肺部感染患者的临床资料。结果病理学明确诊断的侵袭性肺曲霉病11例和临床诊断3例。绝大多数患者有发热，6例患者无明显呼吸道症状。IPA主要诱发因素是长期应用广谱抗生素和糖皮质激素治疗。其临床症状和影像学变化呈非特异性。肺曲霉病85．7％（12／14）患者白细胞计数和中性粒细胞百分比明显升高。及时诊断并使用卡泊芬净治疗，可以降低IPA患者的病死率。结论在肝衰竭患者，高度怀疑有IPA时，如能早期诊断，及时予卡泊芬净治疗可明显改善肝衰竭患者并发侵袭性肺曲霉病的预后。

Clinical analysis of invasive pulmonary aspergiUosis in patients with hepatic failure

Objective To explore the clinical features and optimal for treatment of invasive pulmonary aspergillosis in patients with hepatic failure. Methods A total of 341 cases of hepatic failure who admitted to hospital from November 2005 to September 2007 were analyzed retrospectively. Clinical data, including findings of lung infection, were obtained. Results Of 341 patients with hepatic failure, the diagnosis of IPA was established in 14 cases, including 11 cases diagnosed pathologically and 3 cases clinically. Fever developed in a majority of patients. Obvious respiratory symptoms were absent in 6 patients. The occurrence of IPA was observed to be closely associated with the prolonged duration of use of broadspectrum antibiotics or glucocorticosteroids. Its clinical feature and radiographic findings were non-specific and atypical. Elevated white cell count and percentage of neutrophil were found in 12 cases （85.7%）. Timely diagnose and adequate use of Caspofungin was noted to be related to a decreased mortality of IPA. Conclusions In patients with hepatic failure, when IPA is highly suspected, early diagnose and adequate use of Caspofungin may greatly improve the outcome of IPA.