乙肝病毒相关慢加急性肝功能衰竭患者中侵袭性肺曲霉病的危险因素分析

中国真菌学杂志　 2018, Vol. 13 　Issue (4): 213-216,228.

乙肝病毒相关慢加急性肝功能衰竭患者中侵袭性肺曲霉病的危险因素分析

李明^1,2, 吴振平^1,2, 程晓宇¹, 余婷婷¹, 李小鹏¹, 张伦理^1,2, 张文峰¹

1. 南昌大学第一附属医院感染病科, 南昌 330006;
2. 江西省肝脏再生医学重点实验室, 南昌 330006

收稿日期:2017-11-27 出版日期:2018-08-28 发布日期:2018-08-28
通讯作者: 张文峰,E-mail:wenfengzhang0000@163.com E-mail:wenfengzhang0000@163.com
作者简介:李明,男(汉族),硕士.E-mail:liming7766@sina.com
基金资助:
江西省自然科学基金（20161BAB205254，20161BAB205250）

Risk factors of invasive pulmonary aspergillosis in patients with Hepatitis B virus-related acute-on-chronic liver failure

LI Ming^1,2, WU Zhen-ping^1,2, CHENG Xiao-yu¹, YU Ting-ting¹, LI Xiao-peng¹, ZHANG Lun-li^1,2, ZHANG Wen-feng¹

1. Infectious diseases department of Nanchang University, Nanchang 330006;
2. Jiangxi Key Laboratory of liver regeneration, Nanchang 330006

Received:2017-11-27 Online:2018-08-28 Published:2018-08-28

摘要/Abstract

摘要：

目的探讨乙肝病毒相关慢加急性肝功能衰竭（HBV-ACLF）患者中侵袭性肺曲霉病（IPA）的发生率、危险因素及预后。方法回顾性分析2015年1月~2017年1月住院的283例HBV-ACLF患者临床资料，根据住院期间是否并发IPA将患者分为IPA组和对照组。结果在纳入研究的283例HBV-ACLF患者中，住院期间并发IPA 39例，发生率13.78%。IPA组和对照组患者在2型糖尿病、肺部基础病，入院时基线TBiL水平、MELD评分，糖皮质激素使用、广谱抗生素使用，股静脉置管，住院楼层比较上存在统计学差异（P<0.05）。对单因素分析中存在统计学差异的因素进行logistic回归分析，结果显示，HBV-ACLF患者肺部曲霉菌感染发生的危险因素为：2型糖尿病（OR=8.981，P=0.002）、肺部基础疾病（OR=8.525，P=0.000）、糖皮质激素使用超过3 d（OR=8.856，P=0.000）、广谱强效抗生素使用超过1周（OR=9.823，P=0.000）。HBV-ACLF并发IPA后，病死率达79.48%。结论 HBV-ACLF患者住院过程中易合并IPA。2型糖尿病、肺部基础疾病、真菌感染发生前糖皮质激素使用、广谱抗生素使用等可能是肺部曲霉菌感染的危险因素。HBV-ACLF患者一旦并发IPA，病死率极高。

关键词: 肝衰竭, 侵袭性肺曲霉病, 乙肝病毒, 危险因素

Abstract:

Objective To investigate the incidence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 283 patients with Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) who were hospitalized in our department from January 2015 to January 2017 were recorded. All patients were divided into IPA group and control group according to the status of invasive pulmonary aspergillosis during hospitalization. Results Among the 283 patients with hepatitis B virus-related acute-on-chronic liver failure, 39 cases of definite or probable pulmonary aspergillosis were diagnosed during hospitalization, the incidence was 13.78% (39/283). There were statistically differences (P<0.05) between pulmonary aspergillosis group and control group in type 2 diabetes mellitus, pulmonary underlying diseases, admission baseline TBiL level, MELD score, usage of glucocorticoid, usage of broad-spectrum potent antibiotic, femoral vein catheterization, hospital floor comparison. Logistic regression analysis showed that the risk factors of pulmonary aspergillosis in patients with HBV-ACLF were type 2 diabetes mellitus (OR=8.981,P=0.002), pulmonary basal disease (OR=8.525,P=0.000), usage of glucocorticoid (OR=8.856, P=0.000), usage of broad-spectrum potent antibiotics (OR=9.823,P=0.000). Thirty-one patients with HBV-ACLF and secondary IPA died, the mortality rate was 79.48% (31/39). Conclusion The hospitalized hepatitis B virus related acute-on-chronic liver failure patients were predisposed to invasive pulmonary aspergillosis. Type 2 diabetes mellitus, pulmonary underlying diseases, usage of corticosteroids or broad spectrum antibiotics might be risk factors for pulmonary aspergillosis. Once HBV-ACLF patients complicated with IPA, they might have a poorer prognosis.

Key words: liver failure, invasive pulmonary aspergillosis, HBV, risk factor

中图分类号:

R519.8

李明, 吴振平, 程晓宇, 余婷婷, 李小鹏, 张伦理, 张文峰. 乙肝病毒相关慢加急性肝功能衰竭患者中侵袭性肺曲霉病的危险因素分析[J]. 中国真菌学杂志, 2018, 13(4): 213-216,228.

LI Ming, WU Zhen-ping, CHENG Xiao-yu, YU Ting-ting, LI Xiao-peng, ZHANG Lun-li, ZHANG Wen-feng. Risk factors of invasive pulmonary aspergillosis in patients with Hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Journal of Mycology, 2018, 13(4): 213-216,228.

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