重型乙型肝炎并发自发性腹膜炎患者病原菌分布及临床特征
|
摘要
目的分析重型乙型肝炎并发自发性细菌性腹膜炎(SBP)患者的病原菌分布和临床特征,探索SBP的病原菌分布特点及相关危险因素。方法回顾性分析2012年1月至2017年12月成都市公共卫生临床医疗中心收治的242例重型乙型肝炎患者的临床资料,包括年龄、抗菌药物使用、留置导尿管、留置血管导管和基础疾病;分析患者实验室指标,如肝功能、腹水常规以及腹水培养指标等。按照随机对照法分组:病例组为发生SBP患者(80例),对照组为未发生SBP患者(162例)。结果病例组中18例患者分离出20株病原菌,其中以大肠埃希菌最多(7/20、35.00%)。危险因素的单因素分析显示,病例组患者感染前住院天数> 14 d者显著多于对照组(χ~2=8.99、P <0.001),血清白蛋白<35 g/L患者显著多于对照组(χ~2=22.85、P <0.001),合并其他并发症患者显著多于对照组(χ~2=6.12、P=0.01)。多因素分析显示,血清白蛋白<35 g/L为SBP发生的独立危险因素。结论重型乙型肝炎患者SBP的发病率较高,医务工作者应密切监测SBP的发生。
Objective To analyze the distribution and clinical characteristics of pathogenic bacteria in patients with severe hepatitis B complicated with spontaneous bacterial peritonitis(SBP), and to explore the distribution characteristics and risk factors of SBP. Methods From January 2012 to December 2017, a total of242 patients with severe hepatitis B treated in Chengdu Public Health Clinical Medical Center were collected,retrospectively. Age, use of antimicrobial agents, indwelling catheter and indwelling vascular catheter and basic diseases were anylzed, respectively. The results of laboratory examination, such as liver function, ascites routine and ascites culture, were detected. Patients were divided into observation group(80 cases with SBP) and control group(162 cases without SBP) according to the randomized control method. Results Total of 20 strains of Escherichia coli were isolated from 18 patients in observation group(7/20, 35.00%). Univariate analysis of related factors showed that patients hospitalized longer than 14 days before infection in observation group was significantly more than that of the control group(χ~2 = 8.99, P < 0.001), and patients with serum albumin < 35 g/L were significantly more than those in the control group(χ~2 = 22.85, P < 0.001), patients with other complications in observation group were significantly more than those of the control group(χ~2 = 6.12, P = 0.01). Multivariate analysis showed that serum albumin < 35 g/L was an independent risk factor for SBP. Conclusions The incidence of SBP in patients with severe hepatitis B is high. Clinical medical workers should closely monitor the occurrence of SBP.
Objective To analyze the distribution and clinical characteristics of pathogenic bacteria in patients with severe hepatitis B complicated with spontaneous bacterial peritonitis(SBP), and to explore the distribution characteristics and risk factors of SBP. Methods From January 2012 to December 2017, a total of242 patients with severe hepatitis B treated in Chengdu Public Health Clinical Medical Center were collected,retrospectively. Age, use of antimicrobial agents, indwelling catheter and indwelling vascular catheter and basic diseases were anylzed, respectively. The results of laboratory examination, such as liver function, ascites routine and ascites culture, were detected. Patients were divided into observation group(80 cases with SBP) and control group(162 cases without SBP) according to the randomized control method. Results Total of 20 strains of Escherichia coli were isolated from 18 patients in observation group(7/20, 35.00%). Univariate analysis of related factors showed that patients hospitalized longer than 14 days before infection in observation group was significantly more than that of the control group(χ~2 = 8.99, P < 0.001), and patients with serum albumin < 35 g/L were significantly more than those in the control group(χ~2 = 22.85, P < 0.001), patients with other complications in observation group were significantly more than those of the control group(χ~2 = 6.12, P = 0.01). Multivariate analysis showed that serum albumin < 35 g/L was an independent risk factor for SBP. Conclusions The incidence of SBP in patients with severe hepatitis B is high. Clinical medical workers should closely monitor the occurrence of SBP.
引文
[1]刘牧野.重症肝炎并发医院感染的危险因素分析[J].中华医院感染学杂志,2012,22(16):3560-3562.
[2]陆春雷.重型肝炎的治疗研究进展[J].中外医学研究,2014,12(25):162-164.
[3]邓亚威,刘光伟.慢性重型肝炎的临床研究进展[J].中国中医药现代远程教育,2015,13(24):156-158.
[4]韩津萍,轧春妹,尤炜.肝病患者医院感染的危险因素分析[J].中华医院感染学杂志,2014,24(10):2491-2492.
[5]武立国.重型肝炎并发自发性细菌性腹膜炎30例临床分析探述[J].世界最新医学信息文摘,2017,17(65):181.
[6]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[7]刘雪芹,辛小娟.自发性腹膜炎诊治进展[J].重庆医科大学学报,2018,43(07):943-946.
[8]CLSI(2017)Performance Standards for Antimicrobial Susceptibility Testing.27th Edition.
[9]卢天虎,张勤.32例重型肝炎合并自发性细菌性腹膜炎的治疗体会[J].现代诊断与治疗,2014,25(15):3506-3507.
[10]李发武,吴福全.重型肝炎患者医院内腹腔感染的特点和发病因素分析[J].中国感染控制杂志,2005,4(3):227-229.
[11]Angeloni S,Leboffe C,Parente A,et al.Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice[J].World J Gastroentero,2008,48(17):2757-2762.
[12]Runyon BA.Management of adult patients with ascites due to cirrhosis:anupdate[J].Hepatology,2009,49(6):2087-2107.
[13]张锦前,杨玉英,吴亮,等.肝硬化合并自发性细菌性腹膜炎临床诊断标准及其病原菌分析[J].中国医师进修杂志,2006,29(10):47-49.
[14]马维娟,许建明.肝病并发自发性腹膜炎患者腹水病原菌及其耐药性分析[J].安徽医药,2009,13(9):1066-1068.
[15]荆会霞,赵宁,王俊梅,等.重型肝炎患者医院真菌感染相关因素分析[J].中华医院感染学杂志,2016,26(7):1551-1553.
[16]郑丽花,吴兰笛,陈沁,等.重型病毒性肝炎医院感染危险因素分析[J].当代医学,2009,15(6):41-43.
[17]范珊红,慕彩妮,尚洋,等.医院感染现患率调查及危险因素分析[J].中国感染控制杂志,2013,12(5):351-355.
[18]汪鑫,彭春仙,叶程军,等.肝硬化患者医院感染的危险因素分析与预防[J].中华医院感染学杂志,2015,25(1):169-170,173.
[19]Elzouki AN,Bashir SM,Elahmer O,et al.Prevalence and risk factors of hepatitis D virus infection in patients with chronic hepatitis Binfection attending the three main tertiary hospitals in Libya[J].Arab JGastroenterol,2017,18(4):216-219.
[20]沈桂泉.重型肝炎,肝硬化合并医院感染52例[J].中华传染病杂志,2002,20(6):366-367.
[21]王黎黎,杨淑君,赵瑞红,等.影响乙型肝炎肝硬化合并自发性细菌性腹膜炎患者预后的危险因素分析[J].中西医结合肝病杂志,2016,26(3):158-161.
[22]熊克宫,陈丽芳,柯坤宇,等.乙型肝炎肝硬化腹水并发自发性细菌性腹膜炎的危险因素分析[J].实用临床医学,2014,15(1):13-15,18.
[23]魏秀丽,张国梁.重型肝炎并发医院感染的危险因素分析[J].实用肝脏病杂志,2010,13(2):119-120.
[24]孟清.重型肝炎并发自发性细菌性腹膜炎危险因素探讨[J].临床肝胆病杂志,2005,21(4):227-227.
[25]刘克洲,倪勤,侯伟.重型肝炎治疗的若干问题[J].内科急危重症杂志,2005,11(1):13-16.
[26]Mori S,Fujiyama S.Hepatitis B virus reactivation associated with antirheumatic therapy:Risk and prophylaxis recommendations[J].World J Gastroenterol,2015,21(36):10274-10289.
[2]陆春雷.重型肝炎的治疗研究进展[J].中外医学研究,2014,12(25):162-164.
[3]邓亚威,刘光伟.慢性重型肝炎的临床研究进展[J].中国中医药现代远程教育,2015,13(24):156-158.
[4]韩津萍,轧春妹,尤炜.肝病患者医院感染的危险因素分析[J].中华医院感染学杂志,2014,24(10):2491-2492.
[5]武立国.重型肝炎并发自发性细菌性腹膜炎30例临床分析探述[J].世界最新医学信息文摘,2017,17(65):181.
[6]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[7]刘雪芹,辛小娟.自发性腹膜炎诊治进展[J].重庆医科大学学报,2018,43(07):943-946.
[8]CLSI(2017)Performance Standards for Antimicrobial Susceptibility Testing.27th Edition.
[9]卢天虎,张勤.32例重型肝炎合并自发性细菌性腹膜炎的治疗体会[J].现代诊断与治疗,2014,25(15):3506-3507.
[10]李发武,吴福全.重型肝炎患者医院内腹腔感染的特点和发病因素分析[J].中国感染控制杂志,2005,4(3):227-229.
[11]Angeloni S,Leboffe C,Parente A,et al.Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice[J].World J Gastroentero,2008,48(17):2757-2762.
[12]Runyon BA.Management of adult patients with ascites due to cirrhosis:anupdate[J].Hepatology,2009,49(6):2087-2107.
[13]张锦前,杨玉英,吴亮,等.肝硬化合并自发性细菌性腹膜炎临床诊断标准及其病原菌分析[J].中国医师进修杂志,2006,29(10):47-49.
[14]马维娟,许建明.肝病并发自发性腹膜炎患者腹水病原菌及其耐药性分析[J].安徽医药,2009,13(9):1066-1068.
[15]荆会霞,赵宁,王俊梅,等.重型肝炎患者医院真菌感染相关因素分析[J].中华医院感染学杂志,2016,26(7):1551-1553.
[16]郑丽花,吴兰笛,陈沁,等.重型病毒性肝炎医院感染危险因素分析[J].当代医学,2009,15(6):41-43.
[17]范珊红,慕彩妮,尚洋,等.医院感染现患率调查及危险因素分析[J].中国感染控制杂志,2013,12(5):351-355.
[18]汪鑫,彭春仙,叶程军,等.肝硬化患者医院感染的危险因素分析与预防[J].中华医院感染学杂志,2015,25(1):169-170,173.
[19]Elzouki AN,Bashir SM,Elahmer O,et al.Prevalence and risk factors of hepatitis D virus infection in patients with chronic hepatitis Binfection attending the three main tertiary hospitals in Libya[J].Arab JGastroenterol,2017,18(4):216-219.
[20]沈桂泉.重型肝炎,肝硬化合并医院感染52例[J].中华传染病杂志,2002,20(6):366-367.
[21]王黎黎,杨淑君,赵瑞红,等.影响乙型肝炎肝硬化合并自发性细菌性腹膜炎患者预后的危险因素分析[J].中西医结合肝病杂志,2016,26(3):158-161.
[22]熊克宫,陈丽芳,柯坤宇,等.乙型肝炎肝硬化腹水并发自发性细菌性腹膜炎的危险因素分析[J].实用临床医学,2014,15(1):13-15,18.
[23]魏秀丽,张国梁.重型肝炎并发医院感染的危险因素分析[J].实用肝脏病杂志,2010,13(2):119-120.
[24]孟清.重型肝炎并发自发性细菌性腹膜炎危险因素探讨[J].临床肝胆病杂志,2005,21(4):227-227.
[25]刘克洲,倪勤,侯伟.重型肝炎治疗的若干问题[J].内科急危重症杂志,2005,11(1):13-16.
[26]Mori S,Fujiyama S.Hepatitis B virus reactivation associated with antirheumatic therapy:Risk and prophylaxis recommendations[J].World J Gastroenterol,2015,21(36):10274-10289.