發(fā)布時間：2018-02-28 10:45

  本文關(guān)鍵詞： 終末期肝病 侵襲性真菌感染 氟康唑 伏立康唑 卡泊芬凈　出處：《重慶醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:了解終末期肝病患者并發(fā)侵襲性真菌感染的情況、臨床特點及抗真菌治療的效果,以期取得更好療效,改善臨床預后。方法:回顧性分析102例終末期肝病并發(fā)侵襲性真菌感染的誘因、臨床表現(xiàn)、血常規(guī)、G試驗、影像學特征、真菌學特點、抗真菌治療時機和療效,觀察氟康唑、伏立康唑和卡泊芬凈抗真菌的療效。結(jié)果:102例患者中確診29例(隱球菌4例,念珠菌24例,曲霉菌1例),臨床診斷28例,擬診45例。其中腹部感染50例,肺部37例,血流8例,中樞4例,腹部肺部同時感染3例。均用過1~2個療程的廣譜抗菌藥物,部分患者長期使用糖皮質(zhì)激素。治療前G試驗陽性患者82例。主要臨床表現(xiàn)為腹脹、腹水消難以消退、動力性腸梗阻、利尿效果不好、肝功能無改善、甚至惡化。部分患者出現(xiàn)不同程度的咳嗽、氣促、呼吸困難和發(fā)熱。102例患者中58例口腔肉眼可見毛狀白斑,涂片發(fā)現(xiàn)真菌。外周血白細胞計數(shù)大于10×109/L 58例(56.9%),中性粒細胞分類大于80%79例(77.5%);29例患者CT發(fā)現(xiàn)肺部病變。氟康唑治療17例,治愈10例(58.8%),無效7例;伏立康唑治療23例,治愈15例(65.2%),無效8例;卡泊芬凈治療58例,治愈46例(79.3%),無效12例,治愈率以卡泊芬凈組為高,但無統(tǒng)計學差異。結(jié)論:終末期肝病有高危因素存在,易并發(fā)侵襲性真菌感染,主要病原菌為念珠菌。但臨床癥狀體征無特異性,易漏診,治療時間越早,療效越好�？ú捶覂糁委熃K末期肝病伴發(fā)的侵襲性真菌感染療效高、安全性好,適合臨床應用。
[Abstract]:Objective: to investigate the situation, clinical characteristics and antifungal effect of invasive fungal infection in patients with end-stage liver disease. Methods: the causes, clinical manifestations, blood routine G test, imaging features, mycological characteristics, antifungal treatment timing and efficacy of 102 cases of end-stage liver disease complicated with invasive fungal infection were retrospectively analyzed. Results 29 cases (4 cases of Cryptococcus, 24 cases of Candida, 1 case of Aspergillus, 28 cases of clinical diagnosis and 45 cases of planned diagnosis) were confirmed in 102 cases, including 50 cases of abdominal infection, 37 cases of lung, 8 cases of blood flow. There were 4 cases of central nervous system and 3 cases of simultaneous infection of abdomen and lung. All of them were treated with broad-spectrum antimicrobial agents for 1 ~ 2 courses. Some of them used glucocorticoid for a long time. Before treatment, 82 cases were positive for G test. The main clinical manifestations were abdominal distension, ascites elimination was difficult to disappear. Dynamic intestinal obstruction, diuretic effect, no improvement or even deterioration of liver function. Some patients developed cough, shortness of breath, dyspnea and fever in 58 out of 102 patients. The peripheral blood leukocyte count was greater than 10 脳 10 9 / L in 58 cases (56.9%), neutrophil classification was greater than 80 y (77.5%) and 29 cases were found pulmonary lesions on CT. 17 cases were treated with fluconazole, 10 cases were cured, 7 cases were ineffective, 23 cases were treated with fulconazole. Fifteen cases were cured, 8 cases were ineffective, 58 cases were treated with carpofen, 46 cases were cured with 79.3%, 12 cases were ineffective. The cure rate was high in carpofen group, but there was no statistical difference. Conclusion: there are high risk factors for end-stage liver disease and are prone to complicated with invasive fungal infection. Candida is the main pathogen, but the clinical symptoms and signs are not specific, easy to miss diagnosis, the earlier the treatment time, the better the curative effect. Carbofen Jing treatment of invasive fungal infection associated with end-stage liver disease has high efficacy, good safety, and is suitable for clinical application.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R519;R575

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