重型肝炎合并肺部感染患者相关危险因素的分析以及防治对策

陈仁; 廖金瑶; 陈文莉; 黄晶; 马晓军; 罗晓丹

doi:10.16462/j.cnki.zhjbkz.2016.10.016

重型肝炎合并肺部感染患者相关危险因素的分析以及防治对策

doi: 10.16462/j.cnki.zhjbkz.2016.10.016

广东省人民医院感染科, 广东广州 510080

基金项目:

广东省科技计划项目（2006B36005018）

详细信息

作者简介:
陈仁(1968-),男,海南海口人,教授,博士。主要研究方向:病毒性肝炎的发病机理及生物靶向治疗。

中图分类号: R575.1
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出版历程
- 收稿日期: 2016-05-02
- 修回日期: 2016-08-12

Risk factors analysis and preventive measures for patients with severe hepatitis and lung infection

Department of Infectious Diseases, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China

摘要

摘要: 目的探讨重型肝炎合并肺部感染患者相关危险因素以及防治对策，为临床治疗提供参考依据。方法选取2014年1月~2016年1月在该院接受治疗的482例重型乙型肝炎患者，对确诊为发生肺部感染的患者采用单因素和多因素Logistic回归模型分析重型肝炎合并肺部感染患者相关危险因素，并且采用SPSS 18.0软件对数据进行统计分析。结果 482乙型肝炎肝硬化患者中有98例发生肺部感染，感染率为20.33%；临床特征主要为发烧、咳嗽、咯痰、肺部啰音和影像学改变及血中性粒细胞升高，病死率为21.43%。肺部感染患者中单种病原菌感染72例，混合感染26例。革兰阳性菌53株占47.32%，革兰阴性菌51株占45.54%，真菌8株占7.14%。多因素Logistic回归分析显示年龄、住院时间、严重程度、合并糖尿病、上消化道出血、侵入性操作、使用抗菌药物、血清白蛋白浓度均是合并肺部感染的独立危险因素。结论重型肝炎合并肺部感染患者相关危险因素比较多，故在治疗过程中，需要进行针对性的预防和治疗，以提高重型肝炎患者的存活率。
- 肝炎 /
- 肺 /
- 预后 /
- 危险因素
Abstract: Objective To investigate the predisposing factors and preventive measures of the patients with severe hepatitis and pulmonary infection, and to provide a reference basis for clinical treatment. Methods A total of 482 cases with severe hepatitis were selected from January 2014 to January 2016 in our hospital. Single factor and multiple factors Logistic regression model analyses were used to analyze associated risk factors of pulmonary infection in patients with fulminant hepatitis, and SPSS 18.0 software was used for statistical analysis. Results Of the 482 patients with hepatitis B cirrhosis, 98 cases were with pulmonary infection, and the infection rate was 20.33%; Clinical features such as fever, cough, sputum, lung sounds and chest X-ray, CT changes and elevated blood neutrophils were the most common,the mortality rate was 21.43%. 72 pulmonary infection patients were with a single pathogen infection, while 26 cases were with a mixed infection. 53 (47.32%) strains were of gram positive bacteria, 51 (45.54%) strains were of gram-negative bacteria, eight (7.14%) strains were of fungi. Multivariable Logistic regression analysis showed that age, length of hospital stay, severity, diabetes mellitus, upper gastrointestinal bleeding, invasive operation, use of antimicrobial agents and the concentration of serum albumin were independent risk factors for pulmonary infection. Conclusions There are many factors associated with pulmonary infection in patients with fulminant hepatitis. Therefore, in the process of treatment, it is necessary for targeted prevention and treatment, in order to improve the survival rate of patients with severe hepatitis.
- Hepatitis /
- Lung /
- Risk factors /

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参考文献(22)

段钟平. 重型肝炎肝衰竭临床治疗进展[J]. 中国实用内科杂志, 2005, 25(9):784-786.

苏海滨,王慧芬,林芳,等. 肝衰竭合并真菌感染的调查分析[J]. 中华医院感染学杂志, 2009,19(13):1664-1667.

谭莹,谭庆华,周力. 180例肝硬化病因及并发症分析[J]. 中国医药导报, 2009,6(4):129-131.

Biswas A, Panigrahi R, Pal M, et al. Shift in the hepatitis B virus genotype distribution in the last decade among the HBV carriers from eastern India: Possible effects on the disease status and HBV epidemiology[J]. J Med Virol, 2013,85(8):1340-1347.

中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010年版)[J].实用肝脏病杂志, 2011,14(2):81-89.

中华医学会传染病与寄生虫病学分会,肝病学分会. 病毒性肝炎防治方案[J]. 中华传染病杂志, 2001,19(1):56-62.

Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome[J]. Crit Care Med, 2003,31(3):676-682.

刘春涛. 慢性乙型重型肝炎并发肺部曲霉菌感染危险因素分析[J]. 现代实用医学, 2009,21(10):1105-1106.

Rolando N, Wade J, Davalos M, et al. The systemic inflammatory response syndrome in acute liver failure[J]. Hepatology, 2000, 32(4 Pt 1):734-749.

林雯雯, 高永良. 乙型病毒性肝炎抗病毒类治疗药物研究进展[J]. 中国药业, 2010,19(1):1-3.

何国伟,范红顺,范艳萍. 重型病毒性肝炎医院真菌感染分析[J]. 吉林医学, 2010,31(26):4446-4447.

商振球,雷水贤,朱士宇. 慢性重型肝炎患者并发肺部感染165例临床危险因素分析[J]. 浙江医学, 2007,29(12):1283-1285.

李骥,卢明芹,陈永,等. 重型病毒性肝炎患者深部真菌感染及危险因素分析[J]. 中华传染病杂志, 2002, 20(5):308-309.

王慧芬,张战红,张伟,等. 重型病毒性肝炎医院真菌感染37例分析[J]. 中华医院感染学杂志, 2000,10(1):31-32.

李皇,张耀平,卢平宣. 重型病毒性肝炎真菌感染及耐药性分析[J]. 广东医学, 2011,32(19):2559-2560.

巫晓华. 中西医结合治疗重型病毒性肝炎合并真菌感染的疗效分析[J]. 求医问药:学术版, 2012,10(5):254.

王军,王红旗,周华,等. 传染病专科医院抗生素应用调查[J]. 中华医院感染学杂志, 1998,8:249-250.

刘惠媛,石裕明,李剑萍. 重型病毒性肝炎患者肺部感染情况及其危险因素探讨[J]. 临床肝胆病杂志, 2003,19(6):347-348.

黄彬軻,肖静,吴桂云,等. 214例肺腺癌患者预后因素分析[J]. 中华疾病控制杂志, 2015,19(8):806-810.

李慧. 重型病毒性肝炎患者肺部感染情况及其危险因素探讨[J]. 中国医学工程, 2014,22(10):24-25.

Husová L, Husa P, Ovesná P. The influence of some factors on presence of varices and variceal bleeding in liver cirrhosis patients[J]. Vnitr Lek, 2011,57(1):61-71.

Chaillon A, Schnepf N, Jonas M, et al. Case report: benefits of quantitative polymerase chain reaction in the clinical management of herpes simplex virus 1 infection with prominent hepatitis and unusual secondary progression[J]. J Med Virol, 2012, 84(3):457-461.

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