摘要
目的探讨肝移植术后侵袭性真菌感染(IFI)的高危因素和治疗。方法回顾2005年1月至2018年10月10例肝移植合并侵袭性真菌感染受者的临床诊治经过,从性别、年龄、原发病及严重程度、合并症、术前术后肠道功能等方面分析肝移植术后侵袭性真菌感染的高危因素,并进行文献综述,总结有效的预防和治疗手段。结果肝移植术后IFI受者10例,确诊9例,临床诊断1例。毛霉菌感染受者1例;曲霉菌感染受者4例,其中1例合并新型隐球菌感染;新型隐球菌感染受者2例,其中1例合并曲霉菌感染;念珠菌感染受者7例。受者原发病为慢加急性肝功能衰竭7例,肝性脑病Ⅲ~Ⅳ期2例,合并消化道出血1例,伴肠道功能障碍2例,术前存在肺炎6例。术后1周内发病7例,其中3 d内发病6例。10例受者中9例明确存在肺部病变,4例合并腹腔感染,3例为败血症(1例合并碳青霉烯敏感肺炎克雷白杆菌败血症),2例存在中枢神经系统感染,2例合并皮肤软组织感染,1例为泌尿系统感染。5例死亡,病死率50%(5/10),2例遗留严重神经系统并发症,占40%(2/5)。合并IFI受者生存率显著降低。肝功能衰竭、真菌定植、体内导管留置、合并消化道出血、肠道功能异常等生理屏障破坏、长时间应用广谱抗生素等是肝移植术后IFI危险因素。结论IFI感染的发生与受者术前状态密切相关。病原学检测较困难且用时长,组织活检仍为诊断金标准,高通量测序可作为微生物学检测的辅助手段。加强术前评估,早期合理抗真菌药物应用是有效的治疗措施。
Objective To investigate the risk factors and treatments of invasive fungal infection (IFI) in recipients who underwent liver transplantation (LT).Methods We retrospectively analyzed the frequency and characteristics of IFI in 10 recipients who received LT between January 2005 and October 2018 in Tianjin First Central Hospital and evaluated the risk factors and treatments of IFI after LT.Results Of 10 cases of IFI after LT,9 cases obtained the definite diagnosis and one case clinical diagnosis.There was one case of mucor infection,4 cases of aspergillus infection (1 case was complicated with cryptococcus neoformans infection,2 cases of cryptococcus neoformans infection (one case was complicated with aspergillus infection),and 7 cases of candida infection.The survival rate of patients with IFI was significantly reduced.Liver failure,fungal colonization,indwelling catheter,concomtant gastrointestinal bleeding,intestinal dysfunction,and long-term application of broad-spectrum antibiotics were risk factors of IFI after LT.Conclusion Of 10 cases of IFI,the oceurance of infection in 9 cases is closely related to the preoperative status.Eetiology detection is difficult and takes long time.The biopsy is still the gold standard.High-throughput sequencing can be used as a supplementary means for microbiology detection.Preoperative assessment and early reasonable antifungal drugs are effective treatment measures for IFI after LT.
作者
杨靖波
沈中阳
Yang Jingbo;Sheng Zhongyang(Organ Transplant Department, Tianjin First Central Hospital, Tianjin 300192, China)
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2018年第10期597-601,共5页
Chinese Journal of Organ Transplantation
关键词
肝移植
真菌
感染
Liver transplantation
Fungus
Infection
