目的: 分析重症急性胰腺炎(severe acute pancreatitis,SAP)合并侵袭性真菌感染(invasive fungal infections,IFI)的临床特点及危险因素。方法: 回顾性分析2019年1月至2021年12月收治的84例SAP患者的临床资料,按照是否发生IFI感染,分为IFI组(25例)和非IFI组(59例),分析IFI组患者真菌感染的种类和部位,比较IFI组和非IFI组的临床差异并进行Logistic回归分析。结果: 84例SAP患者中有25例合并IFI,发生率为29.76%;其中8例患者死亡,死亡率为32.00%。病原学检查共检出31株真菌,均为念珠菌;其中白色念珠菌15株(48.40%)、近平滑念珠菌6株(19.35%)、光滑念珠菌6株(19.35%)、热带念珠菌2株(6.45%)、克柔念珠菌2株(6.45%)。SAP患者发生IFI的部位有肺部(80.64%)、腹腔(6.45%)、血液(6.45%)、胆道(3.23%)以及肠道(3.23%)。单因素分析结果显示SAP患者合并IFI与年龄、淋巴细胞计数(×10⁹/L)、降钙素原(procalcitonin,PCT)(ng/mL)、多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)、休克、APACHE Ⅱ评分、全肠外营养(total parenteral nutrition,TPN)时间、抗生素使用时间、抗生素种类数目、尿管留置时间、深静脉置管留置时间、机械通气时间以及ICU住院时间有关(P＜0.05);多因素分析结果显示年龄、PCT、深静脉置管留置时间、机械通气时间以及ICU住院时间是SAP患者合并IFI的独立危险因素(P＜0.05)。结论: SAP合并IFI菌种分布主要为白色念珠菌,主要好发部位为肺部;年龄、PCT、深静脉置管留置时间、机械通气时间以及ICU住院时间是SAP患者合并IFI的独立危险因素。

Objective: To investigate the clinical characteristics and risk factors of severe acute pancreatitis (SAP) combined with invasive fungal infections (IFI). Methods: The clinical data of 84 SAP patients admitted from January 2019 to December 2021 were retrospectively analyzed and divided into the IFI group (25 cases) and the non-IFI group (59 cases) according to whether or not IFI infection occurred. The types and sites of fungal infections in patients in the IFI group were analyzed, and the clinical differences between the IFI and non-IFI groups were compared and analyzed by logistic regression. Results: There were 25 patients among the 84 SAP patients combining with IFI, with an incidence of 29.76%. 8 cases of death occurred in these patients, with a mortality rate of 32.00%. A total of 31 fungal strains were detected in pathogenetic examination, all of which were Candida. Among them, 15 strains of Candida albicans (48.40%), 6 strains of Candida near-smooth (19.35%), 6 strains of Candida smooth (19.35%), 2 strains of Candida tropicalis (6.45%), and 2 strains of Candida kriegerii (6.45%) were detected. The sites of IFI in SAP patients were lung (80.64%), abdominal cavity (6.45%), blood (6.45%), biliary tract (3.23%), and intestine (3.23%). The results of univariate analysis showed that the combination of IFI in SAP patients was associated with age, lymphocyte count (×10⁹/L), procalcitonin(PCT) (ng/mL), multiple organ dysfunction syndrome (MODS), shock, APACHE II score, total parenteral nutrition (TPN) time (d), antibiotic using time (d), number of types of antibiotics used, indwelling time of urinary catheter (d), indwelling time of deep venous catheter (d), mechanical ventilation time (d) and length of ICU stay(h). Multivariate analysis results showed that age, PCT, indwelling time of deep venous catheter (d), mechanical ventilation time (h), and length of ICU stay (h) were independent risk factors of SAP patients complicated with IFI (P＜0.05). Conclusion: The strain distribution of SAP combined with IFI was mainly candida albicans, and the main site of prevalence was the lungs. Age, PCT, duration of deep venous catheterization, mechanical ventilation time, and length of ICU stay were independent risk factors for SAP patients complicated with IFI.