肝硬化失代偿期患者并发自发性腹膜炎的危险因素分析及治疗

陈金强; 李春达; 李富强; 陆利明; 方斌; 金智华

doi:10.16766/j.cnki.issn.1674-4152.002003

肝硬化失代偿期患者并发自发性腹膜炎的危险因素分析及治疗

doi: 10.16766/j.cnki.issn.1674-4152.002003

绍兴市中心医院感染科，浙江绍兴 312030

基金项目:

浙江省医药卫生科技计划项目 2020KY990

详细信息

通讯作者:
金智华，E-mail：523483543@qq.com

中图分类号: R575.2 R572.2
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- 被引次数: 0
出版历程
- 收稿日期: 2020-09-09
- 网络出版日期: 2022-02-16

Analysis and treatment of the risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis

Department of Infectious Diseases, Shaoxing Central Hospital, Shaoxing, Zhejiang 312030, China

摘要

摘要: 目的探讨肝硬化失代偿期患者并发自发性腹膜炎(spontaneous peritonitis，SBP)的危险因素及治疗方法。方法回顾性选择2011年1月—2019年12月在绍兴市中心医院接受诊治的肝硬化失代偿期患者120例，按是否并发自发性腹膜炎将其分为并发组和未并发组，各60例，采用logistic回归分析研究影响肝硬化失代偿期患者并发自发性腹膜炎的危险因素。根据治疗药物的不同将并发组分为哌拉西林舒巴坦组和头孢曲松组，各30例，比较2组临床疗效、炎症因子水平。结果单因素分析显示，消化道出血、SBP既往史、Child-Pugh改良分级评分(Child-Turcotte Pugh score)、总胆红素水平、血钠水平对肝硬化失代偿期患者并发自发性腹膜炎有一定影响(均P < 0.05)。多因素分析显示，消化道出血、Child-Pugh改良分级评分、总胆红素水平是肝硬化失代偿期患者并发自发性腹膜炎的独立危险因素(OR=0.191、0.259、0.922，均P < 0.05)。治疗后，哌拉西林舒巴坦组治疗总有效率明显高于头孢曲松组(P < 0.05)；2组血清降钙素原(PCT)、C-反应蛋白(CRP)水平均明显低于治疗前(均P < 0.05)，且哌拉西林舒巴坦组均明显低于头孢曲松组(均P < 0.05)。结论消化道出血、Child-Pugh高分级、高总胆红素水平是肝硬化失代偿期患者并发自发性腹膜炎的独立危险因素。哌拉西林舒巴坦治疗自发性腹膜炎的临床疗效显著，可有效减轻机体炎症反应。
- 肝硬化 /
- 失代偿期 /
- 自发性腹膜炎 /
- /
- 哌拉西林舒巴坦
Abstract: Objective To explore the risk factors and treatment of spontaneous peritonitis in patients with decompensated liver cirrhosis. Methods A total of 120 patients with decompensated liver cirrhosis who were treated in our hospital from January 2011 to December 2019 were divided into the concurrent group and non-complicated group based on whether they were complicated by spontaneous peritonitis (60 cases in each group). Logistic regression analysis was used to analyse the risk factors of spontaneous peritonitis in patients with decompensated liver cirrhosis. According to the different treatment drugs, the concurrent components were divided into the piperacillin and sulbactam group and ceftriaxone group (30 cases in each group). The clinical efficacy and inflammatory factor levels of the two groups were compared. Results Univariate analysis showed that the incidence of gastrointestinal bleeding, past history of SBP, Child-Pugh classification, total bilirubin level and blood sodium level had a certain effect on patients with decompensated liver cirrhosis complicated with spontaneous peritonitis (all P < 0.05). Multivariate analysis showed that gastrointestinal bleeding, Child-Pugh classification and total bilirubin levels were independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis (OR=0.191, 0.259, 0.922, all P < 0.05). The total effective rate of treatment in the piperacillin and sulbactam group was apparently higher than that in the ceftriaxone group (P < 0.05). After treatment, the levels of serum procalcitonin and C-reactive protein in the two groups were significantly lower than those before treatment (all P < 0.05), and the levels in the piperacillin and sulbactam group were apparently lower than those in the ceftriaxone group (all P < 0.05). Conclusion Gastrointestinal bleeding, high Child-Pugh grade and high total bilirubin levels are independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis. Piperacillin and sulbactam can be used in patients with spontaneous peritonitis to reduce the level of inflammatory factors in the body.
- Liver cirrhosis /
- Decompensated period /
- Spontaneous peritonitis /
- Risk factors /
- Piperacillin and sulbactam

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表 1 肝硬化失代偿期患者并发自发性腹膜炎的单因素分析(例)

组别	例数	性别		年龄(x±s，岁)	糖尿病		消化道出血		肝性脑病		SBP既往史		Child-Pugh改良分级评分(分)		总胆红素(x±s，μmmol/L)	血钠(x±s，mmol/L)
组别	例数	男性	女性	年龄(x±s，岁)	是	否	是	否	是	否	是	否	≥9	< 9	总胆红素(x±s，μmmol/L)	血钠(x±s，mmol/L)
并发组	60	45	15	56.70±10.68	16	44	49	11	10	50	14	46	38	22	69.42±19.36	127.30±15.44
未并发组	60	48	12	57.38±9.42	18	42	35	25	8	52	5	55	15	45	40.83±15.41	134.41±14.85
统计量		0.430^a		-0.372^b	0.164^a		8.044^a		0.261^a		5.065^a		18.639^a		8.950^b	-2.568^b
P值		0.512		0.711	0.685		0.005		0.609		0.024		＜0.001		＜0.001	0.011
注：^a为χ²值，^b为t值。

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表 2 肝硬化失代偿期并发自发性腹膜炎危险因素的变量赋值说明

变量	相关因素	赋值
X1	消化道出血	是=1，否=0
X2	Child-Pugh改良分级评分	≥9分=1， < 9分=0
X4	SBP既往史	是=1，否=0
X3	总胆红素	连续型变量
X5	血钠	连续型变量
Y	肝硬化失代偿期并发自发性腹膜炎	是=1，否=0

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表 3 肝硬化失代偿期患者并发自发性腹膜炎的多因素分析

项目	B	SE	Wald χ²	P值	OR(95% CI)
消化道出血	-1.654	0.684	5.842	0.016	0.191(0.050~0.731)
Child-Pugh改良分级评分	-1.352	0.630	4.604	0.032	0.259(0.075~0.890)
总胆红素	-0.081	0.017	23.471	＜0.001	0.922(0.892~0.953)

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表 4 不同药物治疗肝硬化失代偿期患者并发自发性腹膜炎的总有效率比较[例(%)]

组别	例数	显效	有效	无效	总有效
哌拉西林舒巴坦组	30	16(53.33)	12(40.00)	2(6.67)	28(93.33)
头孢曲松组	30	9(30.00)	13(43.33)	8(26.67)	22(73.33)
注：2组总有效率比较，χ²=4.320，P=0.038。

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表 5 不同药物对肝硬化失代偿期患者并发自发性腹膜炎炎症因子的影响(x ±s)

组别	例数	PCT(μg/L)		CRP(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
哌拉西林舒巴坦组	30	2.34±0.57	0.45±0.10^a	52.62±8.42	18.23±3.45^a
头孢曲松组	30	2.46±0.48	0.95±0.23^a	51.74±7.63	27.62±4.58^a
t值		-0.882	-10.920	0.424	-8.969
P值		0.381	＜0.001	0.673	＜0.001
注：与治疗前比较，^aP < 0.05。

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参考文献(19)

[1]	朱龙川, 甘达凯, 胡青青, 等. 第三代头孢菌素耐药的自发性细菌性腹膜炎发生的预测因素[J]. 临床肝胆病杂志, 2019, 35(7): 1501-1504. doi: 10.3969/j.issn.1001-5256.2019.07.016
[2]	李佩波, 秦凡博, 龚建平. 肝硬化患者肠道屏障与细菌易位的关系[J]. 临床肝胆病杂志, 2019, 35(8): 1854-1857. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGD201908060.htm
[3]	吴莹雯, 张桂灵, 姜宏伟, 等. 哌拉西林舒巴坦治疗肝硬化患者自发性细菌性腹膜炎的临床观察[J]. 中国现代医生, 2019, 57(21): 24-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201921008.htm
[4]	孟樱, 骆欣, 赵国根, 等. 乙肝肝硬化合并自发性细菌性腹膜炎患者血清和腹水中糖链抗原125及降钙素原的变化情况[J]. 中华全科医学, 2017, 15(7): 1239-1241. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201707046.htm
[5]	彭官清, 凌乔, 潘沛沛, 等. 肝硬化并发自发性细菌性腹膜炎患者血清中颗粒蛋白前体水平及临床意义[J]. 中华医院感染学杂志, 2019, 29(23): 3558-3562. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201923011.htm
[6]	OIKONOMOU T, PAPATHEODORIDIS G V, SAMARKOS M, et al. Clinical impact of microbiome in patients with decompensated cirrhosis[J]. World J Gastroentero, 2018, 24(34): 3813-3820. doi: 10.3748/wjg.v24.i34.3813
[7]	YAN D, HUANG Y D, CHEN Y B, et al. Risk factors for Clostridium difficile infection in cirrhotic patients[J]. Hepatobiliary Pancreat Dis Int, 2019, 18(3): 237-241. doi: 10.1016/j.hbpd.2019.04.003
[8]	周鹏. 肝硬化患者血清miR-122的表达及与Child-Pugh分级的关系[J]. 中国老年学杂志, 2017, 37(15): 3802-3803. doi: 10.3969/j.issn.1005-9202.2017.15.071
[9]	谭志洁, 赵静, 刘文兴, 等. 肝硬化腹水患者并发自发性细菌性腹膜炎病原菌与影响因素分析[J]. 中华医院感染学杂志, 2019, 29(19): 2953-2956. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201919018.htm
[10]	RIGHI E. Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions[J]. World J Gastroentero, 2018, 24(38): 4311-4329. doi: 10.3748/wjg.v24.i38.4311
[11]	古川, 宋美怡, 孙文静, 等. 2016年肝硬化领域基础与临床研究进展[J]. 中华肝脏病杂志, 2017, 25(1): 5-8. doi: 10.3760/cma.j.issn.1007-3418.2017.01.003
[12]	方亚平, 陈杏林, 刘文芳, 等. 肝硬化腹水合并自发性细菌性腹膜炎的病原学及危险因素分析[J]. 中华医院感染学杂志, 2017, 27(13): 2924-2927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201713012.htm
[13]	顾君娣, 陆佳敏, 江军, 等. 肝硬化腹水患者合并自发性细菌性腹膜炎病原菌及相关因素分析[J]. 中华医院感染学杂志, 2018, 28(19): 2940-2943. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201819016.htm
[14]	周小兵, 李玉鑫, 高方媛, 等. 肝硬化合并自发性细菌性腹膜炎133例的危险因素分析[J]. 中华消化杂志, 2019, 39(4): 268-270. doi: 10.3760/cma.j.issn.0254-1432.2019.04.010
[15]	熊克宫, 柯坤宇, 孔金峰, 等. 中性粒细胞CD64对自发性细菌性腹膜炎抗生素应用的指导价值[J]. 中国现代医学杂志, 2017, 27(19): 70-73. doi: 10.3969/j.issn.1005-8982.2017.19.014
[16]	FIORE M, MARAOLO A E, GENTILE I, et al. Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review[J]. World J Gastroentero, 2017, 23(25): 4654-4660. doi: 10.3748/wjg.v23.i25.4654
[17]	HUANG C H, PANG L T, XU L C, et al. Risk factors, clinical features, and short-term prognosis of spontaneous fungal peritonitis in cirrhosis: A matched case-control study[J]. World J Clin Cases, 2019, 7(17): 2438-2449. doi: 10.12998/wjcc.v7.i17.2438
[18]	曾婷, 曾凌, 曹先伟, 等. 耐碳青霉烯类铜绿假单胞菌耐药基因与药敏分析[J]. 中华医院感染学杂志, 2019, 29(20): 3063-3067. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201920006.htm
[19]	孙殿静, 代晓茹, 刘晴晴, 等. 舒血宁联合哌拉西林/舒巴坦在2型糖尿病合并下呼吸道感染患者中的应用效果[J]. 中华医院感染学杂志, 2017, 27(10): 2229-2232. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201710018.htm