PDF(895 KB)
PDF(895 KB)
PDF(895 KB)
胆道闭锁患者术后合并侵袭性肺部真菌感染的临床特点分析
A clinical analysis of children with invasive pulmonary fungal infections after biliary atresia surgery
目的 分析胆道闭锁（BA）患儿术后并发侵袭性肺部真菌感染（IPFIs）的临床特点及主要危险因素。方法 回顾性研究49例BA术后合并IPFIs患儿的临床、肺部影像学及病原学特点。并进行BA术后合并IPFIs的危险因素分析。结果 BA患者术后合并IPFIs感染的病原菌依次为白色念珠菌17株（45%）、热带念珠菌7株（18%）、曲霉菌6株（16%）、克柔念珠菌3株（8%）、光滑念珠菌3株（8%）、近平滑念珠菌2株（5%）。主要表现为发热、咳嗽及气促，严重者呼吸困难，其中气促的发生率达78%，35%的患儿无明显啰音。多因素logistic回归分析显示：手术年龄、糖皮质激素使用时间、广谱抗生素累积使用时间、胆管炎反复发作是BA术后IPFIs的主要危险因素。结论 BA患者术后合并的IPFIs前三位病原菌为白色念珠菌、热带念珠菌和曲霉菌。尽早手术、避免反复发作的胆管炎、缩短抗菌药及糖皮质激素的疗程可以减少发生IPFIs的风险。
Objective To investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors.Methods A retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed.Results The most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery.Conclusions The three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.
Biliary atresia / Invasive pulmonary fungal infection / Risk factor / Child
[1] Livesey E, Cortina Borja M, Sharif K, et al. Epidemiology of biliary atresia in England and Wales (1999-2006)[J]. Arch Dis Child Fetal Neonatal Ed, 2009, 94(6):F451-455.
[2] Yoon PW, Bresee JS, Olney RS, et al. Epidemiology of biliary atresia:a population-based study[J]. Pediatrics, 1997, 99(3):376-382.
[3] Lin JS, Chen SC, Lu CL, et al. Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan:A 15-year population-based cohort study[J]. World J Gastroenterol, 2015, 21(46):13080-13086.
[4] Tyraskis A, Davenport M. Steroids after the Kasai procedure for biliary atresia:the effect of age at Kasai portoenterostomy[J]. Pediatr Surg Int, 2016, 32(3):193-200.
[5] 张璟, 林涛, 黄柳明, 等. 胆道闭锁术后反复发作性胆管炎抗感染治疗的中长期随访[J]. 临床小儿外科杂志, 2016, 15(1):20-22.
[6] Tucker RM, Feldman AG, Fenner EK, et al. Regulatory T cells inhibit Th1 cell-mediated bile duct injury in murine biliary atresia[J]. J Hepatol, 2013, 59(4):790-796.
[7] Dillon PW, Owings E, Cilley R, et al. Immunosuppression as adjuvant therapy for biliary atresia[J]. J Pediatr Surg, 2001, 36(1):80-85.
[8] 刘钧澄, 李桂生, 佘锦标,等. 胆道闭锁术后真菌感染[J]. 中华实用儿科临床杂志, 2007, 22(11):820-821.
[9] 中华医学会儿科学分会呼吸学组. 儿童侵袭性肺部真菌感染诊治指南(2009版)[J]. 中华儿科杂志, 2009, 47(2):96-98.
[10] 常莉, 石华, 周伟, 等. 儿童侵袭性真菌感染的临床特征及病原菌分析[J]. 中国当代儿科杂志, 2012, 14(12):933-937.
[11] 文细毛, 任南, 吴安华, 等. 2010年全国医院感染横断面调查感染病例病原分布及其耐药性[J]. 中国感染控制杂志, 2012, 11(1):1-6.
[12] 吴婷婷, 刘艳, 苏堂枫, 等. 儿童肺部侵袭性真菌感染临床特点分析[J]. 中华医院感染学杂志, 2015, 25(22):5239-5243.
[13] 李伟然, 邓思燕, 舒敏, 等. 无基础疾病儿童侵袭性真菌病的临床研究[J]. 中国当代儿科杂志, 2016, 18(8):713-717.
[14] 张菲菲, 郭应坤, 陶于洪. 儿童侵袭性肺曲霉病的临床分析[J]. 中华妇幼临床医学杂志(电子版)[J], 2017, 13(1):88-92.
[15] Dinleyici EC. Pediatric invasive fungal infections:realities, challenges, concerns, myths and hopes[J]. Expert Rev Anti Infect Ther, 2011, 9(3):273-274.
[16] 蔡小芳, 孙继民, 董宗祈, 等. 儿童重症监护病房侵袭性真菌感染38例临床分析[J]. 中国当代儿科杂志, 2013, 15(8):644-648.
[17] 陈贤楠. 重症真菌感染的现状和治疗对策[J]. 中国实用儿科杂志, 2002, 17(3):137-139.
[18] Saracli MA, Fothergill AW, Sutton DA, et al. Detection of triazole resistance among Candida species by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS)[J]. Med Mycol, 2015, 53(7):736-742.
[19] Wiederhold NP. Antifungal resistance:current trends and future strategies to combat[J]. Infect Drug Resist, 2017, 10:249-259.
[20] Verweij PE, Zhang J, Debets AJM, et al. In-host adaptation and acquired triazole resistance in Aspergillus fumigatus:a dilemma for clinical management[J]. Lancet Infect Dis, 2016, 16(11):e251-e260.
