慢性重型乙肝继发侵袭性真菌感染的研究

中国真菌学杂志　 2010, Vol. 5 　Issue (2): 78-81.

慢性重型乙肝继发侵袭性真菌感染的研究

朱定衡¹, 车付彬², 温海¹, 顾菊林¹, 陈江汉¹

1. 第二军医大学附属长征医院皮肤科, 上海, 200003;
2. 北京军区北戴河疗养院皮肤科, 秦皇岛, 066100

收稿日期:2009-11-17 出版日期:2010-04-28 发布日期:2010-04-28
通讯作者: 顾菊林,E-mail:wujgjl@126.com;陈江汉,chenjianghan@126.com E-mail:wujgjl@126.com;chenjianghan@126.com
作者简介:朱定衡,男(汉族),硕士研究生在读.E-mail:z_127140@aina.com

Analysis of invasive fungal infections in patients with chronic severe hepatitis B

ZHU Ding-heng¹, CHE Fu-bin², WEN Hai¹, GU Ju-lin¹, CHEN Jiang-han ¹

1. Mycology Lab., dermatological department, Changzheng Hospital, Shanghai 200003, China;
2. Beidaihe sanatorium, Hebei, China

Received:2009-11-17 Online:2010-04-28 Published:2010-04-28

摘要/Abstract

摘要： 目的明确侵袭性真菌感染(invasive fungal infections,IFI)在慢性重型乙肝患者中发病情况及主要病因。方法依据IFI和乙肝诊断标准,筛选上海长征医院感染科慢性重症乙肝患者,60例IFI者为病例组,66例未发生IFI为对照组,进行回顾性分析。结果 IFI患病率47.62%,病死率40%。乙肝病毒DNA水平是最主要的危险因素,当DNA高于3.16×10³copies/mL,IFI发病可能性增大。结论慢重肝患者IFI的患病率和病死率超出临床预期,降低DNA拷贝可延缓乙肝进展,在预防及治疗IFI中亦具积极意义。

关键词: 慢性重型乙肝, 侵袭性真菌感染, DNA, 危险因素, 白念珠菌

Abstract: Objective To investigate the incidence and cause of invasive fungal infections in patients with chronic severe hepatitis B.Methods A total of 126 chronic severe hepatitis B patients hospitalized in Changzheng Hospital from Jan 2006 to Jan 2009 were recruited,including 60 cases with proven or probable IFIs and 66 cases without IFIs.Epidemiology,risk factors and mortality of IFIs were retrospectively analyzed in this present study.Results The incidence of IFIs was 5% (60/1200) and 47.62% (60/126) in chronic hepatitis B patients and chronic severe hepatitis B patients,respectively.Logistic analysis showed that HBV DNA copy was the most important risk factor of IFIs (P=0.000,OR=1.813,95% CI=1.461～2.252).ROC line analysis revealed that the diagnostic critical value of DNA copy for IFIs was 3.16×10³copies/mL,indicating IFIs would possibly occur if DNA copy was higher than 3.16×10³copies/mL.Conclusions The morbidity of IFIs in patients with chronic severe hepatitis B is unpredictably high.To lower the DNA copies could alleviate the progression of chronic hepatitis B,which is important for prevention and trentment of IFIs.

Key words: Chronic severe hepatitis B, invasive fungal infections, DNA, risk factor, Candida albicans

中图分类号:

R756.6

朱定衡, 车付彬, 温海, 顾菊林, 陈江汉. 慢性重型乙肝继发侵袭性真菌感染的研究[J]. 中国真菌学杂志, 2010, 5(2): 78-81.

ZHU Ding-heng, CHE Fu-bin, WEN Hai, GU Ju-lin, CHEN Jiang-han. Analysis of invasive fungal infections in patients with chronic severe hepatitis B[J]. Chinese Journal of Mycology, 2010, 5(2): 78-81.

参考文献

[1] Li Q,Yuan GY,Tang KC,et al.Prognostic factors for chronic severe hepatitis and construction of a prognostic modal[J].Hepatobiliary Pancreat Dis Int,2008,7(1):40-44.
[2] Liaw YF.Hepatitis B virus replication and liver disease progression:the impact of antiviral therapy[J].Antivir Ther,2006,11(6):669-679.
[3] Graudal N,Milman N,Kirkegaard E,et al.Bacteremia in cirrhosis of the liver[J].Liver,1986,6(5):297-301.
[4] Barnes PF,Arevalo C,Chan LS,et al.A prospective evaluation of bacteremic patients with chronic liver disease[J].Hepatology,1988,8 (5):1099-1103.
[5] Liaw YF,Leung N,Guan R,et al.Asian-Pacific consensus statement on the management of chronic hepatitis B:a 2005 update[J].Liver Int,2005,25 (3):472-489.
[6] Ben De Panw,Thomas J,Walsh J,et al.Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group[J].Chin Infect Dis,2008,46(12):1813-1821.
[7] Netea MG,Van der Meet JW,Kullberg BJ.Role of the dual interaction of fungal pathogens with pattern recognition receptors in the activation and modulation of host defence[J].Clin Microbiol Infect,2006,12(5):404-409.
[8] Eugenia P,Charalampos A,Emmanuel R.The role of immunostimulation in the treatment of invasive fungal infection[J].Current Fungal Infection Reports,2008,2(1):28-35.
[9] Dilip Ratnam,Kumar Visvanathan.New concepts in the immunopathogenesis of chronic hepatitis B:the importance of the innate immune response[J].Hepatol Int,2008,2 (Supplement 1):12-18.
[10] Riordan SM,Skinner N,Kurtovic J,et al.Reduced expression of toll-like receptor 2 on peripheral monocytes in patients with chrouic hepatitis B[J].Clin Vaccine Immunol,2006,13 (8):972-974.
[11] Visvanathan K,Skinner NA,Thompson A J,et al.Regulation of Toll-like receptor-2 expression in chronic hepatitis B by the precore protein[J].Hepatology,2007,45(1):102-110.
[12] Cheng J,Imanishi H,Morisaki H,et al.Recombinant HBsAg inhibits LPS-induced COX-2 expression and IL-18 production by interfering with the NfkappaB pathway in a human monocytic cell line,THP-1[J].J Hepatol,2005,43 (3):465-471.

[1]	丁翔宇, 贾晨虹, 张古英, 李倩, 刘艳辉. 普外科婴幼儿侵袭性真菌感染的高危因素分析与评分系统建立[J]. 中国真菌学杂志, 2020, 15(6): 331-337,353.
[2]	刘瞳瞳, 杜琨. 施慧早产儿侵袭性真菌感染的危险因素[J]. 中国真菌学杂志, 2020, 15(6): 381-384.
[3]	刘丹, 邢丽枝, 杨心茹, 罗伟, 何荣霞. 唑类药物治疗外阴阴道假丝酵母菌病研究进展[J]. 中国真菌学杂志, 2020, 15(5): 318-320.
[4]	赵静宇, 刘意抒, 方伟, 廖万清, 王桂祯, 顾菊林. 新生隐球菌酵母双杂交cDNA文库的构建及鉴定[J]. 中国真菌学杂志, 2020, 15(3): 134-137.
[5]	张文, 罗莹, 国承杰, 徐英春, 肖盟, 类承斌, 赵燕, 毕蕾. 院内念珠菌血症临床特点及病原菌分析[J]. 中国真菌学杂志, 2020, 15(3): 154-160.
[6]	马玉帛, 张逸, 黄晨, 王晓雯, 李若瑜. 自然杀伤细胞在真菌感染免疫的研究进展[J]. 中国真菌学杂志, 2020, 15(3): 175-178.
[7]	邱熙然, 陈思敏, 侯炜彤, 张玉, 郭诗雨, 姜远英, 安毛毛. 白念珠菌侵袭宿主毒力因子研究进展[J]. 中国真菌学杂志, 2020, 15(3): 183-188.
[8]	张园, 杜君洋, 李绘宇, 付彦凯, 粟艳, 周泽奇, 王瑶, 徐英春, 王贺. 陈雪红重症病毒性肺炎合并侵袭性真菌感染早期诊断的现状、问题和对策[J]. 中国真菌学杂志, 2020, 15(3): 189-192.
[9]	张静云, 彭靖雯, 王琼, 高盈, 陈万鑫, 沈永年, Li Dong-mei, 佘晓东, 刘维达. 表皮生长因子受体在阴道念珠菌病发病过程中的作用初探[J]. 中国真菌学杂志, 2020, 15(2): 65-71.
[10]	刘光荣, 翟春涛, 金敏蓉, 李成亮. 天然抗菌剂对5种致病菌的抑制作用研究[J]. 中国真菌学杂志, 2020, 15(2): 88-92.
[11]	谭静文, 徐红, 宋金凤, 高志琴, 杨虹, 杨连娟, 温海. 聚六亚甲基双胍体外抗真菌作用研究[J]. 中国真菌学杂志, 2020, 15(2): 93-96.
[12]	霍晓赛, 贺政新, 王缚鲲. 侵袭性念珠菌感染及其与定植的关系研究进展[J]. 中国真菌学杂志, 2020, 15(2): 125-128.
[13]	范欣, 郭莉娜, 杨洋, 张戈, 段思蒙, 张京家, 徐英春, 杨春霞. 侵袭性感染酵母菌流行病学及耐药性分析[J]. 中国真菌学杂志, 2020, 15(1): 10-14.
[14]	吴永卓, 刘晓明, 张振颖. 孢子丝菌病快速诊断方法的探究[J]. 中国真菌学杂志, 2020, 15(1): 22-25.
[15]	刘晶, 徐稳, 谭志伟, 刘瑶瑶, 周玲玲, 付裕, 龙南彪. 烟曲霉突变体库的构建及伊曲康唑耐药菌的筛选[J]. 中国真菌学杂志, 2020, 15(1): 47-51.