Objective:To investigate the clinical characteristics of liver failure compared with invasive fungal infections and study the risk factors of infections.Mehtods:27 patients with liver failure compared with invasive fungal infections was observed. A cohort of 54 patients with liver failure but without fungal infections served as the control group.Then the clinical characteristics of liver failure compared with invasive fungal infections was identified and the risk factors in fungal infections with liver failure was identified by logic analysis. Results:Of the 27 patients, 37.0%developde fungal infections in lungs,22.2% in the digestive tract,14.8%in the urinary tract,14.8% in the blood and 11.1% in the peritoneal cavity respectively.Candida albicans was the most common bacteria,accounting for 51.9% and aspergillus for 18.5%.Logic regression multivariate analysis identified the following independent risk factors in the fungal infections:invasive medical manuipulation(OR=18.7,P＜0.001),use multiple broad-spectrum antibiotics (OR=8.49,P＜0.001),prolonged administration of corticosteroids (OR=6.31,P＜0.001),declination of leukocyte (OR=2.01,P=0.015) and score of MELD (OR=1.21,P＜0.001). Conclusion: Candida albicans remains the leading pathogen in pulmonary in patients with liver failure.The invasive medical manipulation,use of multiple broad-spectrum antibiotics,prolonged use of corticosteroids,declination of leukocyte and severity of original disease are the independent risk factors of invasive fungal infections in patients with liver failure.%目的 探讨肝衰竭合并侵袭性真菌感染的临床特点,分析感染发生的危险因素.方法 选择我院收治的肝衰竭合并侵袭性真菌感染患者27 例作为研究组,以同时期54 例无真菌感染的肝衰竭患者作为对照组.分析研究组患者的临床特点,并对感染相关的可疑因素行Logic 回归分析.结果 研究组患者感染部位依次为:肺部(37.0%) 、消化道(22.2%) 、泌尿道(14.8%) 、血液(14.8%) 、腹腔(11.1%);感染菌种:白假丝酵母菌(51.9%) 和曲霉菌(18.5%);感染相关多因素分析发现:侵入性操作(OR=18.7;P<0.001) 、联用抗生素≥2种(OR=8.49;P<0.001) 、糖皮质激素(OR=6.31;P<0.001) 、白细胞减少(OR=2.01;P=0.015) 、MELD 评分(OR=1.21;P<0.001) 是真菌感染的独立危险因素.结论 肝衰竭患者多合并肺部的假丝酵母菌感染,其中侵入性操作、联用抗生素≥2种、肾上腺皮质激素、白细胞下降、基础疾病重是真菌感染的危险因素.
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