Clinical features of patients with liver failure and fungal infections and influencing factors for prognosis
-
摘要:
肝衰竭是由多种原因引起的肝功能严重损伤,并发症复杂多样,真菌感染是严重并发症之一,多为肝衰竭晚期表现,严重影响预后,导致病死率显著升高,成为临床工作中面临的棘手问题。介绍了肝衰竭合并真菌感染患者的高危因素、临床特点、诊断方法以及预后影响因素的研究进展,为提高临床诊疗水平提供理论依据,以降低此类患者的病死率,提高其生存质量。
Abstract:Liver failure is severe liver injury due to a variety of causes and has complex and diverse complications. Fungal infection is one of the serious complications of liver failure which often occurs in the advanced stage of liver failure, greatly affects prognosis, and leads to a significant increase in mortality, and therefore, it has become a difficult problem in clinical practice. This article introduces the research advances in high-risk factors, clinical features, diagnostic methods, and prognostic factors in patients with liver failure and fungal infections and provides a theoretical basis for improving the level of clinical diagnosis and treatment, in order to reduce the mortality of such patients and improve their quality of life.
-
Key words:
- liver failure /
- fungai /
- infection /
- risk factors /
- prognosis /
- review
-
[1]ROEHMEL JF, TINTELNOT K, BERNHARDT A, et al.Arxula adeninivorans causing invasive pulmonary mycosis and fungaemia in cystic fibrosis[J].Lancet, 2015, 385 (9976) :1476. [2]HUANG YB, QIAO Y, CHANG LS, et al.Effect of antiviral therapy on prognosis of patients with decompensated cirrhosis[J].Clin JGastroenterol Hepatol, 2011, 20 (4) :331-334. (in Chinese) 黄玉波, 乔雍, 常路丝, 等.抗病毒治疗对失代偿期乙肝肝硬化患者预后的影响[J].胃肠病学和肝病学杂志, 2011, 20 (4) :331-334. [3]XIE GJ, ZHANG HY, CHEN Q, et al.Changing etiologies and outcome of liver failure in Southwest China[J].Virol J, 2016, 13:89. [4]ZHENG MH, SHI KQ, FAN YC, et al.A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure[J].Clin Gastroenterol Hepatol, 2011, 9 (4) :351-356.e353. [5]WANG XL, SHAO JG, ZHU YC, et al.Epidemiological analysis of acute-on-chronic liver failure in Nantong, Jiangsu Province, 2005-2014[J].Chin J Infect Dis, 2016, 34 (9) :530-535. (in Chinese) 汪徐林, 邵建国, 朱永昌, 等.江苏省南通地区2005年至2014年慢加急性肝功能衰竭流行病学调查分析[J].中华传染病杂志, 2016, 34 (9) :530-535. [6]PHILIPS CA, SARIN SK.Sepsis in cirrhosis:Emerging concepts in pathogenesis, diagnosis and management[J].Hepatol Int, 2016, 10 (6) :871-882. [7]HU SY, CHEN YW, PAN ZQ, et al.Risk factors of liver failure-related hospital infection in China:A meta-analysis[J].JZunyi Med Univ, 2014, 37 (5) :520-528. (in Chinese) 胡世芸, 陈妍雯, 潘宗琴, 等.我国肝衰竭医院感染危险因素的Meta分析[J].遵义医学院学报, 2014, 37 (5) :520-528. [8]SCHMIEDEL Y, ZIMMERLI S.Common invasive fungal diseases:An overview of invasive candidiasis, aspergillosis, cryptococcosis, and pneumocystis pneumonia[J].Swiss Med Wkly, 2016, 146:w14281. [9]MATSUBARA VH, BANDARA HM, MAYER MP, et al.Probiotics as antifungals in mucosal candidiasis[J].Clin Infect Dis, 2016, 62 (9) :1143-1153. [10]Society of Infectious Diseases, Chinese Medical Association.Expert consensus on diagnosis and treatment of end-stage liver disease complicated infections[J].J Clin Hepatol, 2018, 34 (9) :1862-1872. (in Chinese) 中华医学会感染病学分会.终末期肝病合并感染诊治专家共识[J].临床肝胆病杂志, 2018, 34 (9) :1862-1872. [11]LING Z, LIU X, CHENG Y, et al.Blood microbiota as a potential noninvasive diagnostic biomarker for liver fibrosis in severely obese patients:Choose carefully[J].Hepatology, 2017, 65 (5) :1775-1776. [12]FIORE M, LEONE S.Spontaneous fungal peritonitis:Epidemiology, current evidence and future prospective[J].World JGastroenterol, 2016, 22 (34) :7742-7747. [13]GRAVITO-SOARES M, GRAVITO-SOARES E, LOPES S, et al.Spontaneous fungal peritonitis:A rare but severe complication of liver cirrhosis[J].Eur J Gastroenterol Hepatol, 2017, 29 (9) :1010-1016. [14]HWANG SY, YU SJ, LEE JH, et al.Spontaneous fungal peritonitis:A severe complication in patients with advanced liver cirrhosis[J].Eur J Clin Microbiol Infect Dis, 2014, 33 (2) :259-264. [15]HASSAN EA, ABD EL-REHIM AS, HASSANY SM, et al.Fungal infection in patients with end-stage liver disease:Low frequency or low index of suspicion[J].Int J Infect Dis, 2014, 23:69-74. [16]LAHMER T, BRANDL A, RASCH S, et al.Fungal peritonitis:Underestimated disease in critically ill patients with liver cirrhosis and spontaneous peritonitis[J].PLo S One, 2016, 11 (7) :e0158389. [17]WANG L, LIU SZ, WANG SY, et al.Effect of broad-spectrum antibiotics on invasive fungal infection induced by intestinal flora disturbance[J].J Trauma Surg, 2010, 12 (4) :306-309. (in Chinese) 王虑, 刘绍泽, 王胜云, 等.广谱抗生素对肠道菌群紊乱诱导的侵袭性真菌感染的影响[J].创伤外科杂志, 2010, 12 (4) :306-309. [18]SINGH JA, CAMERON C, NOORBALOOCHI S, et al.Risk of serious infection in biological treatment of patients with rheumatoid arthritis:A systematic review and meta-analysis[J].Lancet, 2015, 386 (9990) :258-265. [19]JACOBS JW, BIJLSMA JW, van LAAR JM.Glucocorticoids in early rheumatoid arthritis:Are the benefits of joint-sparing effects offset by the adverse effect of osteoporosis?the effects on bone in the utrecht study and the CAMERA-II study[J].Neuroimmunomodulation, 2015, 22 (1-2) :66-71. [20]HAO F, WANG L, ZHOU CJ.Glucocorticoids and invasive fungal infections:A review[J].Chin J Mycol, 2012, 7 (6) :367-371. (in Chinese) 郝飞, 王莉, 周村建.糖皮质激素与侵袭性真菌感染[J].中国真菌学杂志, 2012, 7 (6) :367-371. [21]GUSTOT T, MAILLART E, BOCCI M, et al.Invasive aspergillosis in patients with severe alcoholic hepatitis[J].J Hepatol, 2014, 60 (2) :267-274. [22]CHEN YW, HU SY, PAN ZQ, et al.Meta-analysis of risk factors for fungal infections in liver failure patients in China[J].Chin JNosocomiol, 2014, 24 (10) :2493-2496. (in Chinese) 陈妍雯, 胡世芸, 潘宗琴, 等.我国肝衰竭真菌感染危险因素荟萃分析[J].中华医院感染学杂志, 2014, 24 (10) :2493-2496. [23]ZHANG ZC, ZHANG J, TAN RX, et al.A clinical analysis of liver failure with fungal infection[J].Jiangxi Med J, 2011, 46 (3) :247-249. (in Chinese) 张志成, 张骏, 谭荣欣, 等.肝衰竭合并真菌感染临床分析[J].江西医药, 2011, 46 (3) :247-249. [24]LIN YY, SHIAU S, FANG CT.Risk factors for invasive Cryptococcus neoformans diseases:A case-control study[J].PLo S One, 2015, 10 (3) :e0119090. [25]KIM BS, LEE SG, HWANG S, et al.Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation[J].Transplant Proc, 2009, 41 (1) :250-252. [26]WANG ZW, MENG CP, SHEN HJ, et al.Pathogenic characteristics and related factors of nosocomial infections in patients with severe hepatitis[J].Chin J Nosocomiol, 2018, 28 (4) :535-537, 542. (in Chinese) 王志炜, 孟春萍, 沈华江, 等.重型肝炎患者医院感染病原学特点及相关因素分析[J].中华医院感染学杂志, 2018, 28 (4) :535-537, 542. [27]LIN LN, ZHU Y, CHE FB, et al.Invasive fungal infections secondary to acute-on-chronic liver failure:A retrospective study[J].Mycoses, 2013, 56 (4) :429-433. [28]SU HB, WANG HF, LI C, et al.Liver failure complicated by multi-system invasive fungal infections[J].Infect Dis Info, 2010, 23 (2) :95-97. (in Chinese) 苏海滨, 王慧芬, 李晨, 等.肝衰竭并发多系统侵袭性真菌感染临床分析[J].传染病信息, 2010, 23 (2) :95-97. [29]BENNETT JE.Echinocandins for candidemia in adults without neutropenia[J].N Engl J Med, 2006, 355 (11) :1154-1159. [30] Chinese Invasive Fungal Infection Working Group.The Chinese guidelines for the diagnosis and treatment of invasive fungal disease in patients with hematological disorders and cancers (the fifth revision) [J].Chin J Intern Med, 2017, 56 (6) :453-459. (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 (第五次修订版) [J].中华内科杂志, 2017, 56 (6) :453-459. [31]ZHANG L, LIU ZY.End-stage liver disease and invasive fungal infection[J].Chin J Hepatol, 2018, 26 (1) :13-16. (in Chinese) 张黎, 刘正印.终末期肝病与侵袭性真菌感染[J].中华肝脏病杂志, 2018, 26 (1) :13-16. [32]CHOUDHURY A, KUMAR M, SHARMA BC, et al.Systemic inflammatory response syndrome in acute-on-chronic liver failure:Relevance of'golden window':A prospective study[J].J Gastroenterol Hepatol, 2017, 32 (12) :1989-1997. [33]SARIN SK, CHOUDHURY A.Acute-on-chronic liver failure[J].Curr Gastroenterol Rep, 2016, 18 (12) :61. [34]LIN CC, WANG CC, HUNG KC, et al.Study of porcine hepatocyte-entrapped bioartificial liver in surgery-induced fulminant hepatic failure rabbits[J].Biochem Eng J, 2013, 76 (6) :55-59. [35]KIM TS, JOH JW, MOON H, et al.The different etiology of fulminant hepatic failure (FHF) in Korea and prognostic factors in patients undergoing liver transplantation for FHF[J].Clin Transplant, 2013, 27 (2) :297-302. [36]HU SY, CHEN YW, PAN ZQ, et al.Prognosis of liver failure related hospital infection in China:A Meta-analysis[J].World Chin J Dig, 2014, 22 (21) :3133. [37]GU AB, GONG HY, HUANG MM, et al.Clinical features and prognostic factors of elderly patients with liver failure complicated with fungal infection[J].Chin J Curr Adv Gen Surg, 2017, 20 (5) :358-361. (in Chinese) 郭爱斌, 龚海燕, 黄明敏, 等.肝功能衰竭合并真菌感染老年患者的临床特点及预后影响因素[J].中国现代普通外科进展, 2017, 20 (5) :358-361. [38]ZHAO JM, ZHAO PL, ZHANG L, et al.Relationship between major complications and prognosis of 96 patients with liver failure[J/CD].Chin J Liver Dis:Electr Version, 2018, 10 (3) :77-81. (in Chinese) 赵俊梅, 赵培利, 张璐, 等.96例肝功能衰竭患者主要并发症与预后的相关性[J/CD].中国肝脏病杂志:电子版, 2018, 10 (3) :77-81. [39]YAN T, WANG HF, SU HB, et al.Clinical study of factors in predicting prognosis of patients with hepatic failure after invasive fungal infections[J].J Clin Hepatol, 2009, 25 (2) :110-113. (in Chinese) 闫涛, 王慧芬, 苏海滨, 等.肝衰竭患者合并侵袭性真菌感染后患者转归的影响因素分析[J].临床肝胆病杂志, 2009, 25 (2) :110-113. [40]USHIJIMA Y, TAJIMA T, YOSHIMITSU K, et al.Radiological catheter placement for transcatheter arterial steroid injection therapy to treat severe acute hepatic failure:Technical feasibility and efficacy[J].Acta Radiol, 2012, 53 (2) :140-146. [41]LIN F, WANG HF, SU HB, et al.Impacts of different fungous infections on severity and prognosis of patients with liver failure[J].J Pract Hepatol, 2009, 12 (1) :35-37. (in Chinese) 林芳, 王慧芬, 苏海滨, 等.不同真菌感染对肝衰竭患者病情及预后的影响[J].实用肝脏病杂志, 2009, 12 (1) :35-37. [42]LU H, LI MY, TAN KP, et al.Influence of different fungal infections on the condition and prognosis of patients with liver failure[J].Chin Hepatol, 2017, 22 (4) :332-334. (in Chinese) 陆晖, 李孟英, 谭可平, 等.不同真菌感染对肝衰竭患者病情及预后影响的研究[J].肝脏, 2017, 22 (4) :332-334. [43]ZHANG DJ, ZHOU B, HOU JL.Research progress in prognostic models of acute-on-chronic liver failure[J].J Clin Hepatol, 2018, 34 (6) :1351-1356. (in Chinese) 张东敬, 周彬, 侯金林.慢加急性肝衰竭预后模型的研究进展[J].临床肝胆病杂志, 2018, 34 (6) :1351-1356. [44]WU D, SUN Z, LIU X, et al.HINT:A novel prognostic model for patients with hepatitis B virus-related acute-on-chronic liver failure[J].Aliment Pharmacol Ther, 2018, 48 (7) :750-760. [45]ZHANG H, JIA L, YAO SW, et al.Value of MELD combined with serum sodium concentration in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure in China:A Meta-analysis[J].J Clin Hepatol, 2018, 34 (9) :1950-1955. (in Chinese) 张辉, 贾雷, 姚士伟, 等.MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后预测价值的Meta分析[J].临床肝胆病杂志, 2018, 34 (9) :1950-1955. [46]GRONBAEK H, RODGAARD-HANSEN S, AAGAARD NK, et al.Macrophage activation markers predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure (ACLF) [J].J Hepatol, 2016, 64 (4) :813-822. [47]FISCHER J, SILVA TE, SOARES ESPE, et al.From stable disease to acute-on-chronic liver failure:Circulating cytokines are related to prognosis in different stages of cirrhosis[J].Cytokine, 2017, 91:162-169. [48]BERNAL W, JALAN R, QUAGLIA A, et al.Acute-on-chronic liver failure[J].Lancet, 2015, 386 (10003) :1576-1587. [49]PAPPAS PG, KAUFFMAN CA, ANDES DR, et al.Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J].Clin Infect Dis, 2016, 62 (4) :e1-e50. [50]HUANG Y, LI Z, LEI Y, et al.Diagnosis and treatment of invasive fungal infection in 102 patients with end-stage liver disease[J].J Chongqing Med Univ, 2017, 42 (7) :808-812. (in Chinese) 黄祎, 李哲, 雷宇, 等.102例终末期肝病患者并发侵袭性真菌感染的诊断、治疗研究[J].重庆医科大学学报, 2017, 42 (7) :808-812. [51]CHEN J, YANG Q, HUANG J, et al.Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-onchronic liver failure patients:A retrospective-cohort study[J].Int J Med Sci, 2013, 10 (12) :1625-1631.
计量
- 文章访问数: 1561
- HTML全文浏览量: 17
- PDF下载量: 393
- 被引次数: 0