慢性重型乙肝继发侵袭性真菌感染的研究

目的明确侵袭性真菌感染(invasive fungal infections,IFI)在慢性重型乙肝患者中发病情况及主要病因。方法依据IFI和乙肝诊断标准,筛选上海长征医院感染科慢性重症乙肝患者,60例IFI者为病例组,66例未发生IFI为对照组,进行回顾性分析。结果 IFI患病率47.62%,病死率40%。乙肝病毒DNA水平是最主要的危险因素,当DNA高于3.16×103copies/mL,IFI发病可能性增大。结论慢重肝患者IFI的患病率和病死率超出临床预期,降低DNA拷贝可延缓乙肝进展,在预防及治疗IFI中亦具积极意义。

Analysis of invasive fungal infections in patients with chronic severe hepatitis B

Objective To investigate the incidence and cause of invasive fungal infections in patients with chronic severe hepatitis B.Methods A total of 126 chronic severe hepatitis B patients hospitalized in Changzheng Hospital from Jan 2006 to Jan 2009 were recruited,including 60 cases with proven or probable IFIs and 66 cases without IFIs.Epidemiology,risk factors and mortality of IFIs were retrospectively analyzed in this present study.Results The incidence of IFIs was 5% （60/1 200） and 47.62% （60/126） in chronic hepatitis B patients and chronic severe hepatitis B patients,respectively.Logistic analysis showed that HBV DNA copy was the most important risk factor of IFIs （P=0.000,OR=1.813,95%CI=1.461～2.252）.ROC line analysis revealed that the diagnostic critical value of DNA copy for IFIs was 3.16×10^3copies/mL,indicating IFIs would possibly occur if DNA copy was higher than 3.16×10^3copies/mL.Conclusions The morbidity of IFIs in patients with chronic severe hepatitis B is unpredictably high.To lower the DNA copies could alleviate the progression of chronic hepatitis B,which is important for prevention and trentment of IFIs.