肝硬化失代偿期并发肠道真菌感染的回顾性研究

目的：总结和探讨肝硬化失代偿期合并肠道真菌感染的临床特点、病原菌种类、易感因素、防治及预后。方法：以2004-10～2009-08收治的肝硬化失代偿期患者为调查对象,设合并肠道真菌感染组（32例）和非真菌感染对照组（35例）。对资料进行单因素分析,感染危险因素采用非条件Logistic回归模型分析。结果：肝硬化失代偿期583例次,32例（5.4%）确诊为肠道真菌感染,包括21例经实验室粪便培养阳性证实,11例连续2次粪涂片发现菌丝,但无阳性实验室培养证据。共分离出了7种22株真菌。22例感染者在入院前2周使用了抗菌素。肠道真菌感染以腹胀和顽固性腹泻常见,以稽留热和弛张热型为主。27例肠道真菌感染者外周血白细胞升高。肠道真菌感染后多数患者病情加重,表现为Child-Pugh模型评分增加或死亡。经logistic回归分析,肝功能C级、抗生素使用时间、自发性腹膜炎、食管静脉曲张破裂出血是肠道真菌感染的密切危险因素。依据药物敏感试验抗真菌治疗被认为有效,但缺乏抗真菌药物可能造成肝肾功能进一步损害的评价。统计学分析显示,发生肠道真菌感染的失代偿期肝硬化患者8周内病死率为37.5%,明显高对照组（5.7%）。结论：肠道真菌感染是一种机会感染,伴随肝硬化失代偿期的病理生理改变和肠道微生态环境破坏,促使肠道对真菌的易感性增加。肠道真菌感染增加了肝硬化患者的病死率,防治有相当难度。结合临床症状提高警惕,及时有效的治疗肠道真菌感染是提高其生存率的手段。

A Retrospective Clinical Study of Decompensation Liver Cirrhosis Patients with Intestinal Tract Fungal Infections

Objective：To summarize and analyze the clinical features,pathogens,risk factors,prevention,treatment and prognosis of intestinal fungal infection in patients with decompensated cirrhosis. Methods：To investigate the admitted patients with decompensated cirrhosis in Oct 2004 ～ Aug 2009,32cases as a group of an intestinal fungal infection and 35 cases were allocated to a control group of non-infection. Patients＇ information were compared between the 2 groups by one-way analysis,the multiplicity risk factors of infection analysis are made with unconditional logistic regression. Results：583 cases of decompensated cirrhosis,32cases（5. 4% ） were diagnosed as intestinal fungal infection,in which of 21 cases were confirmed by laboratory enteric stool culture positive and 11cases continuous 2 times fecal smears found hyphae,but no positive laboratory evidence. Isolated 7 kinds 22 strains. 22 cases were confirmed use antibiotics in 2 weeks before admission. Fungal infection with intestinal bloating and refractory diarrhea was the most com-mon,missed heat and thermal-type flip-dominated. 27cases fungal infection of leukocytes were increased. The majority of intestinal fungal infection in patients sicker,model for the Child -Pugh score increased or death. Liver function C -class,time of antibiotic usage,spontaneous bacterial peritonitis,esophageal variceal bleeding are closely related factors of intestinal fungal infection of by the logistic regression analysis. According to a positive drug sensitivity tests of anti-fungal treatment was considered effective,but,there is no evaluation for antifungal agents may result in further damage to liver and kidney function. Statistics shows that mortality rate of intestinal fungal infection in decompensated cirrhosis was 37. 5% in 8 weeks,significantly higher than which of the control group（5. 7% ）. Conclusions：Intestinal fungal infection is a opportunity for infection. Accompanied by pathophysiological changes in decompensated cirrhosis,and the destruction of intestinal micro -ecological environment,both of which promote intestinal damage increases susceptibility to the fun-gus. Intestinal fungal infection increased the mortality rate in patients with cirrhosis,it is a quite difficulty to be prevented. Combined with clinical symptoms,vigilance,decisive and experienced treatment for intestinal fungal infection,which is a effective means to improve patients＇survival rate.