【摘要】 目的 对季也蒙念珠菌感染患者的临床及微生物学特征进行分析，为临床诊治提供参考。 方法 收集2006年1月-2008年12月病原菌培养为季也蒙念珠菌的10例住院患者资料进行回顾性分析。 结果 季也蒙念珠菌感染患者存在多种基础疾病，大多数患者（8/10）有易感因素，其中7例使用广谱抗菌药物。10例中有8例为深部真菌感染。其临床表现与感染部位有关，主要累及泌尿道、呼吸道和皮肤软组织。多数深部感染患者（6/8）在感染前存在同部位细菌感染，部分患者（3/8）在相同部位还可分离出其他真菌。全部季也蒙念珠菌菌株对两性霉素B敏感，大多数菌株（9/10）对氟康唑敏感。仅1例患者因肺部感染、呼吸衰竭死亡，其余患者经氟康唑、伊曲康唑或特比萘芬等抗真菌药物治愈。 结论 季也蒙念珠菌感染多发生于有基础疾病、存在真菌易感因素者，感染部位多为原细菌感染部位，常合并其他细菌或真菌感染。部分菌株对氟康唑和伊曲康唑中敏或耐药，治疗应根据药敏进行选择。【Abstract】 Objective To analyze the clinical and microbiologic characters of candida guilliermondii to improve the clinical diagnosis and treatment. Methods The clinical data of 10 patients with candida guilliermondii infection diagnosed in our hospital from January 2006 to December 2008 were retrospectively analyzed. Results All the patients had several underlying conditions; eight patients had predisposing factors and seven patients were prescribed with broad-spectrum antibacterials. Eight patients had deep mycoses, whose clinical manifestation was associated with the infectious sites, mainly involved in urinary tract, respiratory tract and skin-soft tissues. Most deep mycoses (6/8) had prior bacterial infection at the candida guilliermondii infection site; some patients (3/8) had other fungous infection at the same time. All the strains were sensitive to amphotericin B; most fungous strains (9/10) were sensitive to fluconazole. One patient died of pulmonary infection and respiratory failure, and the others were cured by fluconazole, itraconazole or terbinafine. Conclusion Candida guilliermondii infection mainly occurs in patients with underlying conditions and predisposing factors. The infectious sites have prior bacterial infection and bacterial infection or fungous infection at the same time. Since some candida guilliermondii strains were not sensitive to fluconazole and itraconzole, drug sensitive test should be consulted.
Drugs may induce hepatitis B virus (HBV) reactivation (HBV-R). Here we have reviewed the definition and harm of HBV-R, the risk drugs and their underlying mechanism, the influence factors, as well as the early intervention measures. It is shown that multiple drugs, including chemotherapy drugs, immunotherapy drugs, directly acting antivirals, cell therapy, etc., can induce HBV-R by affecting host immunity or directly activating HBV transcription factors. HBV-R could cause severe liver damage, even interruption of treatment of original diseases, affecting the prognosis of patients. Through precisely identifying risk drugs, monitoring the influence factors, and prescribing preventive anti-HBV regimen if necessary, the incidence of HBV-R can be significantly reduced. It is also suggested that clinical physicians should not only pay attention to the early identification and intervention of HBV-R, but also further study the mechanism of HBV-R in depth, especially the underlying mechanism between host, HBV and risk factors. This will help to promote the discovery of more valuable markers for risk prediction and targets for early intervention, and to further reduce the risk of HBV-R and improve the prognosis of patients.
Objective To explore the safety and efficacy of plasma diafiltration (PDF) in the treatment of liver failure. Methods Patients with liver failure requiring artificial liver treatment in West China Hospital of Sichuan University from December 2020 to December 2022 were selected and divided into three groups according to treatment modality: PDF group, double plasma molecular adsorption system (DPMAS) group and plasma exchange (PE) group. Serum albumin levels and total bilirubin (TB) levels were tested before and after treatments to compare the clearance of these substances among three groups. Adverse events were recorded. Results A total of 88 patients were included, with a total of 179 treatments conducted. Among them, 27 cases in PDF group were treated for 62 times. In PE group, 18 cases were treated for 33 times. In DPMAS group, 43 cases were treated for 84 times. There were no significant differences between the three groups in age, sex, TB, international standardized ratio, albumin, hemoglobin, blood pH value, blood sodium, blood potassium, blood free calcium, or lactate (P>0.05). There was no statistically significant difference in the absolute value of TB decrease, percentage of TB decrease, absolute value of albumin change, and percentage of albumin change before and after treatment among the three groups (P>0.05). Transient hypotension occurred in one patient in DPMAS group. There were two and three allergic reactions in PDF and PE groups, respectively. In addition, 2 patients in PE group had hypocalcemia. Conclusions PDF can be safely used in patients with liver failure, and its therapeutic effect on reducing bilirubin is similar to DPMAS and PE groups. Compared with PE, it needs less plasma supplement. As it can provide ultrafiltration, PDF would be helpful in patients with liver failure accompanied by renal insufficiency oliguria.