目的 分析肝衰竭患者合并念珠菌肺炎的临床特点。 方法 回顾性调查住院期间诊断为念珠菌肺炎的肝衰竭患者150例。 结果 发病前90%患者有广谱抗生素应用史，47.3%有肾上腺皮质激素应用史。73%患者表现为单纯肺部感染；66%为单纯白色念珠菌。临床表现主要为发热（70%，105/150），咳嗽、咳痰（85.3%, 128/150）。50%患者外周血白细胞总数升高，47.3%中性粒细胞百分比升高。抗真菌治疗疗程2周以上者较小于2周者预后好（ P ＜0.001）。发热、白细胞升高时即使用抗真菌药物较胸片明确有影像学改变时再用药临床预后好（ P ＜0.001）。 结论 肝衰竭患者合并念珠菌肺炎大多有广谱抗生素应用史；以白色念珠菌多见；临床主要表现为发热、咳嗽、咳痰，早期使用有效抗真菌药并疗程大于2周预后较好。
Abstract
Objective To investigate the clinical features and risk factors of candidal pneumonia in liver failure patients. Methods 150 hospitalized patients with candidal pneumonia from January 1986 to December 2007were analysed retrospectively. Results Broad-spectrum antibiotics were used in 90.0% of the patients and corticosteroids 47. 3% of the patients. 73% of the patients had only lung fungal infection. The main species of Candida was Candida albicans (66%) and Candida tropicalis (16%). Fever (70%) cough and expectoration(85.3%) were the most common clinical features. Leucocytosis was found in 50% of the patients and neutrophil increased in 46.7%. Better effect was achieved when the anti-fungal therapy was initiated earlier or along with long-term therapy regimen (≥2 weeks). Conclusions Most Candidal pneumonia patients with liver failure are given broad-spectrum antibiotics. Candida albicans is popularly used. Fever, cough and expectoration are the most common clinical features. Better outcomes come with early use and sufficient duration of antibiotics.
关键词
念珠菌病 /
肺炎 /
肝衰竭
Key words
candida /
pneumonia /
liver failure
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参考文献
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基金
国家“十一五”艾滋病和病毒性肝炎等重大传染病防治“科技重大专项”资助（2008X10002-005-6）
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