Clinical features and risk factors for patients with liver failure complicated by invasive pulmonary aspergillosis
-
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...
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.
-
Key words:
- liver failure /
- lung diseases /
- fungal
-
[1]ZICKER M,COLOMBO AL,FERRAZ-NETO BH,et al.Epidemiology of fungal infections in liver transplant recipients:a sixyear study of a large Brazilian liver transplantation centre[J].Mem Inst Oswaldo Cruz,2011,106(3):339-345. [2] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA;Severe Liver Diseases and Artificial Liver Group,Chinese Society of Hepatology,CMA.Guideline for diagnosis and treatment of liver failure(2012 version)[J].Chin J Clin Infect Dis,2012,5(6):321-327.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝治疗组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华临床感染病杂志,2012,5(6):321-327. [3] Chinese Invasive Fungal Infections Cooperative Group.Diagnostic criteria and therapeutic principle of invasive fungal disease in patients with blood diseases/malignant tumors(4th revised edition)[J].Chin J Intern Med,2013,52(8):704-709.(in Chinese)中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准与治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709. [4]MAERTENS J,MARCHETTI O,HERBRECHT R,et al.European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients:summary of the ECIL 3---2009 update[J].Bone Marrow Transplant,2011,46(5):709-718. [5]SHI Y.Update of diagnosis and treatment of invasive pulmonary fungal diseases[J].Chin J Tuberc Respir Dis,2011,34(2):83-85.(in Chinese)施毅.侵袭性肺真菌病诊治的再认识[J].中华结核和呼吸杂志,2011,34(2):83-85. [6]BOFF C,ZOPPAS BC,AQUINO VR,et al.The indoor air as a potential determinant of the frequency of invasive aspergillosis in the intensive care[J].Mycoses,2013,56(5):527-531. [7]PELEZ T,MUOZ P,GUINEA J,et al.Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit[J].Clin Infect Dis,2012,54(3):e24-e31. [8]GANGNEUX JP,ADJIDCC,BERNARD L,et al.Quantitative assessment of fungal risk in the case of construction works in healthcare establishments:proposed indicators for the determination of the impact of management precautions on the risk of fungal infection[J].J Mycol Med,2012,22(1):64-71. [9]FOURNEL I,SAUTOUR M,LAFON I,et al.Airborne aspergillus contamination during hospital construction works:efficacy of protective measures[J].Am J Infect Control,2010,38(3):189-194. [10]KPELI E,ULUBAY G,BAYRAM AKKURT S,et al.Invasive pulmonary aspergillosis in heart transplant recipients[J].Exp Clin Transplant,2015,13(Suppl 1):352-355. [11]NAGAO M,FUJIMOTO Y,YAMAMOTO M,et al.Epidemiology of invasive fungal infections after liver transplantation and the risk factors of late-onset invasive aspergillosis[J].J Infect Chemother,2016,22(2):84-89. [12]CHEN J,YANG Q,HUANG J,et al.Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients:a retrospective-cohort study[J].Int J Med Sci,2013,10(12):1625-1631. [13]WU Z,LING Z,SHAO F,et al.Invasive pulmonary aspergillosis in patients with acute-on-chronic liver failure[J].J Int Med Res,2012,40(5):1958-1965.
计量
- 文章访问数: 2483
- HTML全文浏览量: 13
- PDF下载量: 441
- 被引次数: 0