摘要
目的感染性胰腺坏死(infected pancreatic necrosis,IPN)是导致急性胰腺炎(acute pancreatitis,AP)患者死亡的主要原因之一。目前多数研究关注于细菌感染所致病例的特点,而合并真菌感染的IPN的临床特征尚不明确。本研究揭示了合并真菌感染的IPN患者的临床特征,并分析了可能影响患者死亡的风险因素。方法分析2017年1月1日至2021年12月31日首都医科大学宣武医院普通外科收治的IPN患者的临床资料。依据患者胰腺坏死组织及引流液培养是否有真菌感染,分为真菌感染组和无真菌感染组。比较两组患者的基线资料、临床特点与结局,并分析真菌感染组患者死亡的风险因素。结果研究共纳入214个病例,其中真菌感染组49例。真菌感染组患者的坏死物累及区域更广、红细胞压积更低、入院时血糖更高;真菌感染组患者出现多重耐药菌感染(multidrug-resistant bacteria,MDRB)比例更高,总住院时间、入住重症监护病房(intensive care unit,ICU)时间及接受肠外营养时间也更长。与无真菌感染组相比,真菌感染组接受手术患者的比例及手术干预次数相近(P>0.05),但真菌感染组患者术前器官功能衰竭及术后新发器官功能衰竭患者的比例更高,死亡率也更高(P<0.05)。真菌感染的菌种以白色念珠菌(44.8%)最为常见,其次是近平滑念珠菌(28.6%)和热带念珠菌(8.2%)。单因素Logistic回归分析显示,合并MDRB感染(OR=1.37,95%CI:1.02~1.83)、出现真菌血症(OR=1.53,95%CI:1.06~2.23)、高血糖(OR=1.65,95%CI:1.28~2.10)、术后新发器官功能衰竭(OR=1.65,95%CI:1.19~2.29)及出血性并发症(OR=1.64,95%CI:1.28~2.10)是影响真菌感染组患者死亡的风险因素;多因素Logistic回归分析的结果与单因素分析结果一致。结论真菌感染增加IPN患者的死亡率,也增加术后患者发生新发器官功能衰竭的发生率。关注真菌血症、MDRB感染、高血糖、器官功能衰竭及术后出血有助于降低患者死亡风险。
Objective To analyze the clinical features of patients with infected pancreatic necrosis(IPN) complicated with fungal infection so as to identify possible risk factors for death.Methods We analyzed the clinical data of patients with IPN admitted to Xuanwu Hospital Capital Medical University from January 1,2017 to December 31,2021.According to the results of pancreatic necrotic tissue and drainage fluid culture,the patients were divided into the group with fungal infection and the group without fungal infection.The baseline data,clinical features and outcomes of the two groups were compared,and the risk factors for death in patients with fungal infection were analyzed.Results We included a total of 214 patients in the study,of whom 49 patients in the fungal infection group had wider necrotic involvement,lower hematopoietic volume,and higher blood glucose at admission.Patients with fungal infection had a higher proportion of multidrug-resistant bacteria(MDRB),and hospital and ICU stay as well as parenteral nutrition duration were also longer.In the group of patients with fungal infection,the proportion of patients undergoing surgery did not increase(P>0.05),but the proportion of patients with perioperative organ failure and death was higher(P<0.05).Candida albicans(44.8%) was the most common fungus detected,followed by Candida parapsilosis(28.6%) and Candida tropicalis(8.2%).Logistic regression analysis showed that MDRB infection(OR=1.37,95% CI:1.02-1.83),fungemia(OR=1.53,95% CI:1.06-2.23),hyperglycemia(OR=1.65,95% CI:1.28-2.10),new organ failure(OR=1.65,95% CI:1.19-2.29) and bleeding complications(OR=1.64,95% CI:1.28-2.10) after surgery were risk factors for death in patients with fungal infection.Conclusion Fungal infection increases mortality in patients with IPN and the incidence of new organ failure after surgery.Attention to fungemia,MDRB infection,hyperglycemia,organ failure and postoperative bleeding can help reduce the risk of death.
作者
曹锋
李昂
王喆
梅文通
卢炯地
李非
CAO Feng;LI Ang;WANG Zhe;MEI Wentong;LU Jiongdi;LI Fei(Xuanwu Hospital Capital Medical University,Beijing 100053;Clinical Center of Acute Pancreatitis,Capital Medical University,Beijing 100053,China)
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2024年第2期206-211,共6页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
北京市医管局科研培育计划项目(No.PX2023030)
首都卫生发展科研专项(首发2020-1-2012)
首都医科大学临床医学高精尖学科建设项目(No.1192070312)。
关键词
急性胰腺炎(AP)
胰腺坏死
真菌感染
临床特征
acutepancreatitis(AP)
pancreaticnecrosis
fungalinfection
clinicalcharacteristic
