Department of Dermatology, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
Mycoses. 2013 Jul;56(4):429-33. doi: 10.1111/myc.12044. Epub 2013 Feb 1.
Although the consequences of invasive fungal infections (IFIs) secondary to chronic hepatitis B infections secondary IFIs are serious, the incidence and main pathogenic factors of IFIs in acute-on-chronic liver failure (ACLF) patients remain unclear. This study included 1200 hepatitis B patients who were treated in the Department of Infectious Diseases, Shanghai Changzheng Hospital from January 2006 to January 2009. Patients with ACLF were screened according to the diagnostic guidelines for liver failure. Patients with ACLF and secondary IFI were the disease group, and patients with ACLF without secondary IFI were the controls. The incidence of IFI, mortality, and possible IFI causes in two groups were evaluated retrospectively. Sixty patients with ACLF had secondary IFI, of which 14 were confirmed cases and 46 were suspected cases. The incidence of IFI was 47.62% for ACLF patients. Logistic regression analysis showed that the level of hepatitis B viral (HBV) DNA was an important risk factor for secondary IFI in ACLF patients. Receiver operating characteristic curve analysis suggested that when the number of HBV DNA copies was higher than 3.16 × 10(3) copies ml(-1) , the possibility of secondary IFI in ACLF patients increased significantly, while white blood cell levels showed protective effects for these patients. The incidence of IFI is high in ACLF patients and high hepatitis B virus DNA levels may be an independent risk factor of secondary IFI in these patients.
虽然慢性乙型肝炎（HBV）感染后继发侵袭性真菌感染（IFI）的后果严重，但急性肝衰竭（ACLF）患者中 IFI 的发生率和主要致病因素仍不清楚。本研究纳入了 2006 年 1 月至 2009 年 1 月在上海长征医院感染科接受治疗的 1200 例 HBV 患者。根据肝衰竭的诊断标准筛选出 ACLF 患者。将合并继发性 IFI 的 ACLF 患者作为疾病组，无继发性 IFI 的 ACLF 患者作为对照组。回顾性评估两组患者 IFI 的发生率、死亡率和可能的 IFI 病因。60 例 ACLF 患者继发 IFI，其中确诊病例 14 例，疑似病例 46 例。ACLF 患者的 IFI 发生率为 47.62%。Logistic 回归分析显示，HBV DNA 载量是 ACLF 患者继发 IFI 的重要危险因素。受试者工作特征曲线分析提示，当 HBV DNA 载量高于 3.16×10(3) 拷贝/ml 时，ACLF 患者继发 IFI 的可能性显著增加，而白细胞计数则对患者具有保护作用。ACLF 患者的 IFI 发生率较高，HBV DNA 载量高可能是此类患者继发 IFI 的独立危险因素。
