目的 了解肝移植后受体发生真菌感染的特点,分析相关危险因素,并探讨预防措施。方法 回顾性分析我院肝移植中心2003年1月~2005年1月实施的195例肝移植患者发生真菌感染的情况。结果 195例肝移植患者,有25例发生真菌感染,共分离出40株真菌,感染率为12.8%。其中25株为白假丝酵母(62.5%),9株为光滑假丝酵母(22.5%),5株为热带假丝酵母(12.5%),1株为曲霉(2.5%);感染部位以呼吸道为主(占49.0%)。真菌感染与移植前后广谱抗生素应用时间、住院总天数、静脉导管使用天数、术后24h白细胞和中性粒细胞数、术后24h总胆红素、直接胆红素以及输血量有明显相关性(P<0.05)。肝移植真菌感染死亡3例,病死率12%。结论 多种临床易感因素均可导致肝移植术后真菌感染,尽量缩短广谱抗生素使用时间、严格掌握静脉穿刺的适应证、缩短导管留置时间、及时监测血常规和肝功能、控制并发症,是预防肝移植术后真菌感染的重要措施。

Objective The goal of the current study was to determine the characteristics of fungal infection in liver transplant recipients, analyze the associated risk factors, and to further examine prophylactic measures taken to prevent such infections. Methods One hundred and ninety five liver transplant recipients were retrospectively studied in the Liver Transplant Center between January 2003 to January 2005. Results Fungal infection occurred in 25 of 195 recipients with the morbidity rate of 12.7%. Forty strains of fungi were isolated including 25 cases of Candida albicans (62.5%), 9 cases of C. glabrata (22.5%), 5 cases of C. tropicalis (12.5%) and 1 case of C. guilliermondii (2.5%). The majority of infections occurred in the respiratory tract (49%). Compared to the control group, the most common risk factors associated with fungal infection in liver transplant recipients were (1) long-term administration of broad-spectrum antibiotics both pre-and post-operation, (2) the total number of days the patient stayed in the hospital, (3) the amount of time a vein catheter had to remain in place, (4) the counts of white blood cells and neutrophil cells 24 hours post-operation, (5) the levels of the total and direct bilirubin and (6) the total volume of blood received during the operation. Three out of 195 recipients (12%) died as a result of fungal infection. Conclusion Multiple risk factors can lead to a fungal infection after liver transplantation. Results from this study indicate that certain preventative measure must be taken in order to eliminate or reduce the severity and/or occurence of fungal infections following liver transplantation including narrowing the course of broad spectrum antibiotics, adopting an strict indication of vein puncture, shortening the number of days a vein catheter stays in place, and post-operation monitoring white blood cell counts and hepatic function. if(document.getElementById('ChDivSummary').innerHTML!=""){CutSpan('ChDivSummary',500);DisplaySpanDiv('ChDivSummary');ClearSummaryOnLoad('SummaryLinkChID','SummaryLinkEnID');}else{CutSpan('EnDivSummary',1000);DisplaySpanDiv('EnDivSummary');ClearSummaryOnLoad('SummaryLinkEnID','SummaryLinkChID');}