Yuan Man, Han Ning, Lv Duoduo, Huang Wei, Zhou Mengjie, Yan Libo, Tang Hong
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China.
Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, China.
J Fungi (Basel). 2024 Aug 14;10(8):571. doi: 10.3390/jof10080571.
We aim to investigate the characteristics of invasive pulmonary aspergillosis (IPA) in patients with HBV-related acute on chronic liver failure (HBV-ACLF).
A total of 44 patients with probable IPA were selected as the case group, and another 88 patients without lung infections were chosen as the control group.
HBV-ACLF patients with probable IPA had more significant 90-day mortality (38.6% vs. 15.9%, = 0.0022) than those without. The white blood cell (WBC) count was the independent factor attributed to the IPA development [odds ratio (OR) 1.468, = 0.027]. Respiratory failure was associated with the mortality of HBV-ACLF patients with IPA [OR 26, = 0.000]. Twenty-seven patients received voriconazole or voriconazole plus as an antifungal treatment. Plasma voriconazole concentration measurements were performed as therapeutic drug monitoring in 55.6% (15/27) of the patients. The drug concentrations exceeded the safe range with a reduced dosage.
The WBC count might be used to monitor patients' progress with HBV-ACLF and IPA. The presence of IPA increases the 90-day mortality of HBV-ACLF patients mainly due to respiratory failure. An optimal voriconazole regimen is needed for such critical patients, and voriconazole should be assessed by closely monitoring blood levels.
我们旨在研究乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者侵袭性肺曲霉病（IPA）的特征。
共选取44例疑似IPA患者作为病例组，另选88例无肺部感染患者作为对照组。
疑似IPA的HBV-ACLF患者90天死亡率（38.6%对15.9%，P = 0.0022）高于无IPA的患者。白细胞（WBC）计数是IPA发生的独立因素[比值比（OR）1.468，P = 0.027]。呼吸衰竭与疑似IPA的HBV-ACLF患者的死亡率相关[OR 26，P = 0.000]。27例患者接受伏立康唑或伏立康唑联合其他药物抗真菌治疗。55.6%（15/27）的患者进行了血浆伏立康唑浓度测定作为治疗药物监测。药物浓度在减少剂量时超过安全范围。
白细胞计数可用于监测HBV-ACLF和IPA患者的病情进展。IPA的存在主要由于呼吸衰竭增加了HBV-ACLF患者的90天死亡率。对于此类重症患者需要优化伏立康唑治疗方案，并且应通过密切监测血药浓度来评估伏立康唑。
