| 摘要: |
| 目的 探讨人工肝治疗后重症肝病并发侵袭性真菌感染（IFI）的部位、菌种分布及危险因素。方法 对本院2019年10月至2025年8月收治的476例人工肝治疗后的重症肝病患者进行回顾性研究分析，根据是否并发IFI分为观察组和对照组,统计患者的真菌感染部位、菌种分布，对年龄、性别、人工肝次数、住院天数、肝功能Child-Pugh评分、白细胞（WBC）、血红蛋白（HGB）、血小板（PLT）、总胆红素（TBIL）、白蛋白（ALB）、凝血酶原活动度（PTA）、国际标准化比值（INR）、血氨（AMM）、是否合并并发症（消化道出血、肝性脑病、肝肾综合征等）、是否使用糖皮质激素、是否使用广谱抗生素≥2周等进行单因素及多因素Logistics回归分析。结果 本院收治476例患者中出现57例IFI，IFI发生率为11.97%；57例IFI患者共检出70株真菌，主要感染部位为多部位感染（占63.2%），主要致病真菌为白色念珠菌（32.8%）、烟曲霉菌（27.1%）、热带念珠菌（12.9%）、光滑念珠菌（10.0%）。经单因素分析，IFI组和非IFI组年龄、人工肝次数、WBC、ALB、合并并发症、使用糖皮质激素、使用广谱抗生素≥2周比较，存在统计学上的显著性差异（P＜0．05）。经多因素分析，年龄、人工肝次数、WBC、ALB、使用广谱抗生素≥2周是人工肝治疗后重症肝病并发IFI的危险因素（P＜0．05）。结论 人工肝治疗后重症肝病并发IFI部位主要为多部位感染，主要致病真菌有念珠菌属和曲霉属，危险因素包括年龄、人工肝次数、WBC、ALB、使用广谱抗生素≥2周。 |
| 关键词: 人工肝 重症肝病 侵袭性真菌感染 危险因素 |
| DOI： |
| 分类号: |
| 基金项目:昆明市卫生健康委员会卫生科研资助项目 |
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| Clinical Characteristics and Risk Factors of Invasive Fungal Infection in Severe Liver Disease Patients after Artificial Liver |
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刘梦君1,2,3
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1.the 3rd People'2.'3.s Hospital of Kunming
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| Abstract: |
| Objective To explore the sites, distribution and risk factors of invasive fungal infection (IFI) in severe liver diseases patients after artificial liver treatment.Methods A retrospective analysis was conducted on 476 patients with severe liver diseases who received artificial liver treatment at the 3rd People's Hospital of Kunming from October 2019 to August 2025. They were divided into the observation group and the control group according to whether they were complicated with IFI. The sites and distribution of fungal infection in the patients were statistically analyzed. The analyses univariate and multivariate logistic regression were used to analyze age, gender, the number of artificial liver treatments, length of hospital stay, Child-Pugh score of liver function, WBC, HGB, PLT, TBIL, ALB, PTA, INR, and AMM, whether there are complications (such as gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, etc.), whether glucocorticoids are used, and whether broad-spectrum antibiotics have been used for≥2 weeks.Results Among the 476 patients admitted, 57 cases of IFI occurred, and the incidence of IFI was 11.97%. A total of 70 strains of fungi were detected in 57 IFI patients. The main infection sites were multi-site infections (accounting for 63.2%), and the main pathogenic fungi were Candida albicans (32.8%), Aspergillus fumigatus (27.1%), Candida tropicalis (12.9%), and Candida glabra (10.0%). After univariate analysis, there were statistically significant differences in age, the number of artificial liver treatments, WBC, ALB, concurrent complications, the use of glucocorticoids, and the use of broad-spectrum antibiotics for ≥2 weeks between the IFI group and the non-IFI group (P<0.05). After multivariate analysis, age, the number of artificial liver treatments, WBC, ALB, and the use of broad-spectrum antibiotics for ≥2 weeks were identified as risk factors for IFI in severe liver diseases patients after artificial liver treatment(P<0.05).Conclusion The sites of IFI in severe liver diseases patients after artificial liver treatment are mainly multi-site infections. The main pathogenic fungi are Candida and Aspergillus. The risk factors include age, the number of artificial liver treatments, WBC, ALB, and the use of broad-spectrum antibiotics for ≥2 weeks. |
| Key words: Artificial liver Severe liver diseases IFI Risk factors |
