肝衰竭合并侵袭性肺曲霉菌病的临床特点及危险因素分析

肖二辉; 宁会彬; 康谊; 曹永革; 魏君锋; 尚佳

doi:10.3969/j.issn.1001-5256.2016.07.036

肝衰竭合并侵袭性肺曲霉菌病的临床特点及危险因素分析

DOI: 10.3969/j.issn.1001-5256.2016.07.036

河南省人民医院感染科

基金项目:

河南省科技计划项目(162102310156)；国家临床重点专科资助项目；

详细信息

中图分类号: R575.3;R519.8
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出版历程
- 出版日期: 2016-07-20

Clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis

Research funding:

摘要

摘要:
目的探讨肝衰竭合并侵袭性肺曲霉菌病（IPA）患者的临床特点和危险因素,为临床诊治提供参考。方法收集2010年1月-2014年12月河南省人民医院诊治的肝衰竭患者447例,回顾性分析其中合并IPA患者的临床特征、实验室指标及影像学检查结果。另随机选取同期住院且年龄相近未合并肺部感染的肝衰竭患者49例作为对照。计量资料组间比较采用独立样本t检验;计数资料组间比较采用χ2检验或Fisher’s精确概率法。采用多因素Logistic回归分析肝衰竭合并IPA的危险因素。结果 447例肝衰竭患者发生IPA 43例（9.6%）。年龄（P=0.023）、合并肝性脑病（P=0.021）、长期广谱抗菌药物使用（P=0.007）、激素的应用（P=0.016）和深静脉置管（P<0.001）是IPA发生的独立危险因素。肝衰竭合并IPA患者的临床表现缺乏特异性,肺部CT改变以双肺多发结节、肿块影和近胸膜楔形实变较常见,典型的晕轮征和空气新月征较少见。35例接受抗真菌治疗的患者中30例好转或治愈,3例死于消化道出血,2例死于肺部感染,其余未接受治疗的患者全部死亡。结论肝衰竭患者存在诸多发...
- 肝功能衰竭 /
- 肺疾病,真菌性 /
- 危险因素
Abstract:
Objective To investigate the clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis( IPA),and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 477 patients with liver failure who were diagnosed and treated in Henan Provincial People's Hospital from January 2010 to December 2014 were collected,and the clinical features,laboratory markers,and results of imaging examinations of patients with IPA were retrospectively analyzed. Another 49 patients with liver failure who were hospitalized within the same period,had similar ages,and were not complicated by pulmonary infection were randomly selected as controls. The independent samples t- test was used for comparison of continuous data between groups,the chi-square test or Fisher's exact test were used for comparison of categorical data between groups,and multivariate logistic regression analysis was performed to analyze the risk factors for liver failure complicated by IPA. Results Among the 447 patients with liver failure,43( 9. 6%) were complicated by IPA. Age( P = 0. 023),hepatic encephalopathy( P = 0. 021),long- term use of broad- spectrum antibiotics( P = 0.007),use of hormone( P = 0. 016),and deep venous catheterization( P < 0. 001) were independent risk factors for the development of IPA. Clinical manifestations of liver failure patients with IPA lacked specificity. Lung CT scan showed multiple nodules,masses,and wedge- shaped consolidation near the pleura in both lungs,but typical halo sign and air crescent sign were rarely seen. Among the 35 patients who received antifungal therapy,30 were improved or cured,3 died of digestive tract bleeding,2 clied of plumonary infection,and all the other patients who did not receive therapy also died. Conclusion Patients with liver failure have various risk factors for the development of IPA,and the clinical manifestations are not typical,with high incidence and fatality rates. Early detection and treatment is the key to improving survival rates.
- liver failure /
- lung diseases /
- fungal

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参考文献(13)

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