慢性重型肝炎并发侵袭性肺曲霉感染临床分析

摘要

Objective To evaluate the clinical features of chronic severe hepatitis complicated with invasive pulmonary aspergillosis. Methods The clinical data of 17 cases of chronic severe hepatitis complicated with invasive pulmonary aspergillosis were analyzed retrospectively and compared with another 34 concurrent patients with chronic severe hepatitis who were not complicated with invasive pulmonary aspergillosis. Results Tbil and ALT did not show significant difference between the two groups. In comparison with the control group, Ptal% was significantly lower but WBC count significantly higher in the patients complicated with invasive pulmonary aspergillosis (P<0. 01). The patients with invasive pulmonary aspergillosis were often associated with hepatic encephalopathy and severe ascites (P<0. 01 versus control group). The duration of antibiotic therapy was more than three weeks in both groups. More patients with invasive pulmonary aspergillosis received invasive procedures, glucocorticoids and broad-spectrum antibiotics (e. G. Carbapenems) as compared with the control group (P<0. 01). Conclusions The development of invasive pulmonary aspergillosis in the patients with chronic sever hepatitis was associated with the severity of underlying liver disease, complications, number of invasive procedures, prior glucocorticoids or carbapenems treatment.%目的 观察慢性重型肝炎并发侵袭性肺曲霉感染临床特点.方法 回顾性分析并比较17例慢性重型肝炎并发侵袭性肺曲霉感染(观察组)与34例同期住院慢性重型肝炎未合并真菌感染患者(对照组)的临床资料.结果 两组患者的TBil、ALT水平差异无统计学意义；与对照组相比,观察组患者凝血酶原活动度(PTa％)更低、WBC计数更高,两组间差异有统计学意义(P＜0.01)；观察组出现腹水及肝性脑病的患者例数明显增加(与对照组相比,P＜0.01)；两组患者使用抗生素的时间均超过3周,在治疗过程中,观察组进行侵袭性操作的次数、使用糖皮质激素和应用碳青霉烯类抗生素的例数明显多于对照组(P＜0.01).结论 慢性重型肝炎并发侵袭性肺曲霉感染与肝病严重程度、并发症的发生、侵袭性操作次数、使用糖皮质激素、碳青霉烯类抗生素应用有一定的相关性.