本文選題：肝移植 + 真菌感染　； 參考：《南昌大學(xué)》2015年碩士論文

【摘要】：目的:探究肝移植術(shù)后真菌感染的特點(發(fā)生率、時間、部位、類型、耐藥規(guī)律)及術(shù)前原發(fā)疾病、肝功能狀況、術(shù)前并發(fā)癥對術(shù)后真菌感染的影響;為真菌感染的早期診斷提供實驗依據(jù),為肝移植患者術(shù)后提供預(yù)防和治療真菌感染的臨床依據(jù)。方法:采用病例-對照研究,回顧性分析江西省人民醫(yī)院器官移植中心2005年4月-2014年4月期間實施的115例肝移植術(shù)患者的臨床資料,根據(jù)患者癥狀、體征及影像學(xué)檢查結(jié)果綜合分析,并收集相關(guān)標(biāo)本進行真菌培養(yǎng),明確是否真菌感染及感染類型,根據(jù)真菌培養(yǎng)結(jié)果將移植術(shù)后患者分為兩組:感染組(真菌培養(yǎng)陽性),未感染組(真菌培養(yǎng)陰性);對感染組標(biāo)本再行藥敏實驗,觀察真菌耐藥性情況,計量資料以均數(shù)±標(biāo)準(zhǔn)差(sx±)表示,組間比較采用t檢驗;計數(shù)資料以率表示,組間比較用c2檢驗;按a=0.05檢驗水準(zhǔn),以P0.05具有統(tǒng)計學(xué)意義。比較兩組病例在肝原發(fā)性疾病、術(shù)前肝功能情況,術(shù)前并發(fā)癥對術(shù)后真菌感染的差異,并分析其原因。結(jié)果:1、在行肝移植術(shù)患者的原發(fā)疾病中,重癥肝炎患者術(shù)后真菌感染比例為41.6%,非重癥肝炎術(shù)后真菌感染18.1%,重癥肝炎與非重癥肝炎患者相比,感染組與未感染組有統(tǒng)計學(xué)差異(P0.05),其它原發(fā)性肝病患者行肝移植術(shù)后,感染組與未感染組進行分析無統(tǒng)計學(xué)差異(P0.05)。2、術(shù)前肝功能Child-pugh評分與Meld評分,Child C級和Meld評分25分患者中,感染組與未感染組感染情況對比,有統(tǒng)計學(xué)差異(P0.05)。3、術(shù)前并發(fā)癥中,發(fā)現(xiàn)腹水2000ml,胸水500ml,低白蛋白血癥,肝腎綜合征,嚴(yán)重貧血5種因素在感染組和未感染組中有統(tǒng)計學(xué)差異(P0.05)。4、患者移植手術(shù)時間及其真菌感染率:3-5月組移植數(shù)30例(30/115,26.08%),感染率為(9/30,30.0%);6-8月組移植數(shù)27例(27/115 23.47%),感染率為(3/32,18.51%);9-11月組移植數(shù)32例(32/115,27.82%),感染率為(3/32,9.37%);12-2月組移植數(shù)26例(26/115,22.60%),感染率為(12/26,46.15%)。不同手術(shù)月份分組中感染組與未感染組進行c2檢驗,計算P=0.01,有統(tǒng)計學(xué)差異(P0.05)。5、29例患者有14例首次真菌感染發(fā)生在移植手術(shù)后4周內(nèi),占48.27%,24例患者真菌感染發(fā)生在術(shù)后8周占82.75%。6、29例發(fā)生真菌感染患者總共培養(yǎng)出62株菌株,總共檢出7種真菌分別為:白色念珠菌51.6%、曲霉菌16.1%、光滑念珠菌9.6%、煙曲霉菌4.8%、熱帶念珠菌8.0%、酵母樣菌4.8%、近平滑假絲酵母菌8.0%。白色念珠菌發(fā)病率最高,痰液是最常見的陽性標(biāo)本,67.7%的陽性標(biāo)本是從痰液標(biāo)本培養(yǎng)獲得的,呼吸系統(tǒng)和消化系統(tǒng)是肝移植術(shù)后真菌易感部位。7、肝移植術(shù)后真菌感染,經(jīng)微生物學(xué)實驗共檢出62株,7種真菌,以氟康唑及兩性霉素B最易耐藥,耐藥率分別為37.09%、29.03%。結(jié)論:1、原發(fā)疾病為重癥肝炎患者,在肝移植術(shù)后易真菌感染;伴有胸腹水、低蛋白血癥、肝腎綜合征并發(fā)癥的患者,術(shù)后感染真菌概率增高。2、術(shù)前進行肝功能Child-pugh與MELD評分,可作為預(yù)測肝移植術(shù)后真菌感染的依據(jù)。評分等級越高或分?jǐn)?shù)越大,患者術(shù)后越易發(fā)生真菌感染。3、肝移植術(shù)后真菌感染一般發(fā)生在術(shù)后2月以內(nèi),以呼吸系統(tǒng)及消化系統(tǒng)感染為主,常見真菌為白色念珠菌。4、術(shù)后患者真菌感染時間發(fā)生以每年的12月-2月居多,感染與氣候有關(guān)。5、減少氟康唑及兩性霉素B用藥頻率,降低真菌耐藥率。
[Abstract]:Objective: To explore the characteristics of fungal infection after liver transplantation (incidence, time, location, type, drug resistance) and pre operation disease, liver function and the effect of preoperative complications on postoperative fungal infection, provide experimental basis for early diagnosis of fungal infection, and provide a clinical basis for the prevention and treatment of fungal infection after liver transplantation. Methods: a case-control study was used to review the clinical data of 115 patients with liver transplantation during the April -2014 year of April 2005 in the Jiangxi People's Hospital organ transplantation center, to analyze the symptoms, signs and imaging findings of the patients, and to collect the related specimens for fungal culture and to identify the fungal infection and the sense of infection. After the fungal culture, the patients were divided into two groups: infection group (fungal culture positive), uninfected group (negative fungus culture), drug sensitivity test of the infection group, observation of fungal resistance, measurement data with mean standard deviation (SX +), t test in groups, rate of count data, and among groups Compared with C2 test, according to a=0.05 test level, P0.05 had statistical significance, compared two groups of cases in primary liver disease, preoperative liver function, preoperative complications of postoperative fungal infection, and analysis of the causes. Results: 1, in the primary disease of patients with liver transplantation, the proportion of postoperative fungal infection in severe hepatitis patients was 41.6%. There was a statistical difference between the infection group and the uninfected group (P0.05). There was no statistical difference between the infection group and the uninfected group (P0.05).2 after the liver transplantation (P0.05).2, and the preoperative liver function score and Meld score, Child C grade. Among the patients with the Meld score of 25, the infection group was compared with the uninfected group, and there was a statistical difference (P0.05).3. In the preoperative complications, the 5 factors of ascites, 2000ml, 500ml, hypoalbuminemia, hepatorenal syndrome, and severe anemia were statistically different (P0.05).4, and the time and true of the transplant operation were true. Bacterial infection rate: 3-5 months group transplantation number (30/115,26.08%), infection rate (9/30,30.0%); 6-8 months group transplantation number (27/115 23.47%), infection rate (3/32,18.51%); 9-11 month group 32 cases (32/115,27.82%), infection rate (3/32,9.37%); 12-2 months group transplantation number (26/115,22.60%), infection rate (12/26,46.15%). Different operation months group C2 test was carried out between the middle infection group and the uninfected group, and the P=0.01 was calculated. There was a statistical difference (P0.05). There were 14 cases of first fungal infection in.5,29 cases, which occurred within 4 weeks of the transplant operation, accounting for 48.27%. 24 cases of fungal infection occurred in 8 weeks after the operation and 62 strains were cultivated in 82.75%.6,29 cases, and 7 fungi were detected in total. Not as: Candida albicans 51.6%, Aspergillus 16.1%, Candida albicans 9.6%, Aspergillus fumigatus 4.8%, Candida albicans 8%, yeast like bacteria 4.8%, Candida albicans 8.0%., Candida albicans, sputum are the most common positive specimens, 67.7% positive specimens are obtained from sputum specimens, the respiratory system and digestive system are liver Fungal susceptibility to.7 after transplantation and fungal infection after liver transplantation, 62 strains and 7 fungi were detected by microbiological experiments. Fluconazole and amphotericin B were the most susceptible, the drug resistance rate was 37.09%, respectively, 29.03%. conclusion: 1, the primary disease was severe hepatitis, and the fungal infection was easy after liver transplantation; with thoracic and ascites, hypoproteinemia and hepatorenal syndrome. In patients with complications, the incidence of fungal infection after operation increased by.2. Preoperative liver function Child-pugh and MELD score could be used as a basis for predicting fungal infection after liver transplantation. The higher the grade or the greater the score, the more susceptible to fungal infection after the operation, the more susceptible to fungal infection after the operation. The fungal infection usually occurred within February after the operation, with respiratory system. The main fungi are Candida albicans.4, the common fungi are Candida albicans. The fungal infection time of the patients after the operation is mostly in the year of December -2 months. The infection is associated with the climate related.5, reducing the frequency of fluconazole and amphotericin B, and reducing the rate of fungal resistance.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.3

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