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目的系统评价我国肝衰竭医院内真菌感染的相关危险因素,预防肝衰竭患者医院内真菌感染发生,改善预后。方法分别检索CBM、CNKI、VIP、Wanfang、Pubmed、ISI、Embase、Cochrane数据库文献,采用NOS标准对纳入文献进行质量评价及荟萃分析。结果纳入10篇文献,肝衰竭1 284例,合并医院内真菌感染642例;荟萃分析结果显示:肝衰竭患者死亡比例在感染组与非感染组之间差异有统计学意义(OR=2.69),感染组发生死亡比例更高;肝衰竭患者使用激素(OR=2.72)、广谱抗菌药物(OR=4.14)、应用侵入性操作(OR=3.80)在感染组与非感染组间差异均有统计学意义;肝衰竭患者外周血白细胞减少比例在感染组与非感染组间差异有统计学意义(OR=2.65);MELD评分在感染组与非感染组之间差异有统计学意义(MD=11.28)。结论医院内真菌感染是影响肝衰竭患者预后的重要因素,使用激素、抗菌药物、进行侵入性操作、白细胞减少及MELD评分升高为肝衰竭医院内真菌感染的重要危险因素。
Objective To systematically evaluate the risk factors associated with fungal infection in liver failure hospitals in China and prevent the occurrence of fungal infections in hospitals with liver failure and improve the prognosis. Methods The literature of CBM, CNKI, VIP, Wanfang, Pubmed, ISI, Embase and Cochrane databases were searched, and the quality of inclusion documents and meta-analysis were analyzed by NOS standard. Results There were 10 articles including 1 284 cases of liver failure and 642 cases of fungal infection in the hospital. The meta-analysis showed that the proportion of deaths in patients with liver failure was significantly different between infected and non-infected patients (OR = 2.69) The incidence of death in infected group was higher than that in non-infected group (OR = 2.72), broad-spectrum antibiotics (OR = 4.14) and invasive operation (OR = 3.80) (OR = 2.65). The difference of MELD score between infected and non-infected patients was statistically significant (MD = 11.28 ). Conclusion Fungal infection in hospitals is an important factor affecting the prognosis of patients with liver failure. The use of hormones, antibiotics, invasive procedures, leukopenia and elevated MELD scores are important risk factors for fungal infections in hospital with liver failure.