美罗培南与头孢曲松防治肝硬化并发上消化道出血患者院内感染效果对比分析
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摘要
目的探讨应用美罗培南对肝硬化(LC)并发上消化道出血(UGB)患者院内感染的预防作用,为防治医院感染提供参考。方法 2015年1月~2016年1月我科收治的Child-Pugh B/C级LC并发UGB患者86例,随机分为两组,每组43例。两组在综合治疗的基础上,分别接受美罗培南或头孢曲松预防院内感染治疗。采用酶联荧光分析法检测血清降钙素原(PCT),采用偶氮显色基质法检测血清内毒素(ETX),采用ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-8和γ-干扰素。结果在治疗14 d,美罗培南组感染率和再出血率分别为9.3%和14.0%,显著低于头孢曲松组的25.6%和32.6%,差异有统计学意义(P<0.05),;两组4周内病死率分别为18.6%和20.9%,差异无统计学意义(P>0.05);治疗7 d,美罗培南组血清PCT、ETX、TNF-α、IL-8和IFN-γ水平分别为(0.32±0.05)ng/ml、(10.3±2.5)pg/ml、(20.5±3.6)ng/ml、(12.3±1.9)ng/ml和(19.1±3.6)ng/ml,除IFN-γ外,均显著低于头孢曲松组【分别为(0.40±0.05)ng/ml、(13.1±3.1)pg/ml、(24.2±3.9)ng/ml、(14.8±2.0)ng/ml和(16.3±3.5)ng/ml,P<0.05】。结论对于LC并发UGB患者预防性应用美罗培南可有效降低近期感染率和再出血率,值得进一步验证。
Objective To investigate the preventive effect of meropenem on nosocomial infections in cirrhotic patients complicated by upper gastrointestinal bleeding(UGB). Methods 86 patients liver cirrhosis(LC)complicated by UGB were recruited in our hospital between January 2015 and January 2016,and were divided into two groups by the random computer-generated numbers,with 43 cases in each group. All patients received conventional hemostatic and hepatoprotective therapy,and meropenem or ceftriaxone sodium intravenously for seven to ten days. Serum procalcitonin(PCT),endotoxin(ETX),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-8 and interferon-γ(IFN-γ) were detected. Results At the end of two weeks,the rates of infections and rebleeding in meropenem group were 9.3% and 14.0%,much lower than 25.6% and 32.6%(P<0.05) in ceftriaxone group and the 4-week mortality rates were 18.6% and 20.9%,respectively(P>0.05);at the end of seven days,serum levels of PCT,ETX,TNF-α,IL-8 and IFN-γ in meropenem group were(0.32±0.05)ng/m L,(10.3±2.5)pg/ml,(20.5±3.6)ng/ml,(12.3±1.9)ng/ml and(19.1±3.6)ng/ml,all but IFN-γ,much lower than(0.40 ±0.05)ng/ml,(13.1 ±3.1)pg/ml,(24.2 ±3.9)ng/ml,(14.8 ±2.0)ng/ml and(16.3 ±3.5)ng/ml(P <0.05) in ceftriaxone group.Conclusions Meropenem could be effectively used to reduce the infection and rebleeding rates in cirrhotic patients at the urgent circumstance of UGB,which warrants further investigation.
Objective To investigate the preventive effect of meropenem on nosocomial infections in cirrhotic patients complicated by upper gastrointestinal bleeding(UGB). Methods 86 patients liver cirrhosis(LC)complicated by UGB were recruited in our hospital between January 2015 and January 2016,and were divided into two groups by the random computer-generated numbers,with 43 cases in each group. All patients received conventional hemostatic and hepatoprotective therapy,and meropenem or ceftriaxone sodium intravenously for seven to ten days. Serum procalcitonin(PCT),endotoxin(ETX),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-8 and interferon-γ(IFN-γ) were detected. Results At the end of two weeks,the rates of infections and rebleeding in meropenem group were 9.3% and 14.0%,much lower than 25.6% and 32.6%(P<0.05) in ceftriaxone group and the 4-week mortality rates were 18.6% and 20.9%,respectively(P>0.05);at the end of seven days,serum levels of PCT,ETX,TNF-α,IL-8 and IFN-γ in meropenem group were(0.32±0.05)ng/m L,(10.3±2.5)pg/ml,(20.5±3.6)ng/ml,(12.3±1.9)ng/ml and(19.1±3.6)ng/ml,all but IFN-γ,much lower than(0.40 ±0.05)ng/ml,(13.1 ±3.1)pg/ml,(24.2 ±3.9)ng/ml,(14.8 ±2.0)ng/ml and(16.3 ±3.5)ng/ml(P <0.05) in ceftriaxone group.Conclusions Meropenem could be effectively used to reduce the infection and rebleeding rates in cirrhotic patients at the urgent circumstance of UGB,which warrants further investigation.
引文
[1]Botwin GJ,Morgan TR.Bacterial infections in cirrhosis.Hepatol Int,2014,8(Suppl 2):467-474.
[2]Watts MR,Gupta V,Liddle C.Antimicrobials in cirrhotic patients after upper gastrointestinal hemorrhage:One size no longer fits all.Clin Gastroenterol Hepatol,2016,14(2):324-325.
[3]郝勇,谭萍,赵亚刚,等.肝硬化食管胃底静脉曲张出血患者预防性抗菌治疗的前瞻性研究.实用肝脏病杂志,2012,15(1):29-31.
[4]Restellini S,Nendaz M,Morard I.Antibiotic prophylaxis in liver cirrhosis.Rev Med Suisse,2012,8(326):276-281.
[5]中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[6]中华人民共和国卫生部.医院感染诊断标准.北京:中华人民共和国卫生部,2009:119-125.
[7]Garcia TG.Current management of the complications of cirrhosis and portal hypertension:Variceal hemorrhage,ascites,and spontaneous bacterial peritonitis.Dig Dis,2016,34(4):382-386.
[8]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.中华医院感染学杂志,2015,25(1):169-170.
[9]Mouelhi L,Ayadi H,Zaimi Y,et al.Predictive scores of early mortality from variceal gastrointestinal bleeding in cirrhotic patients.Tunis Med,2016,94(11):670-676.
[10]Noveloso B,Bastiampillai B,Perni N,et al.Antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding.Am Fam Physician,2017,95(9):582-588.
[11]张晓亮.某院革兰阴性杆菌对美罗培南与亚胺培南体外敏感性比较.中国医院药学杂志,2015,35(5):447-449.
[12]魏丽荣,刘景院,宋丽红.肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况.中华实验和临床感染病杂志(电子版),2013,7(3):71-74.
[13]张鹏亮,徐修礼,白露.医院感染大肠埃希菌及肺炎克雷伯菌的产酶率与耐药性分析.中华医院感染学杂志,2015,25(3):508-510.
[14]Thevenot T,Degand T,Grelat N,et al.A French national survey on the use of antibiotic prophylaxis in cirrhotic patients.Liver Int,2013,33(3):389-397.
[15]Fernández J,Tandon P,Mensa J,et al.Antibiotic prophylaxis in cirrhosis:Good and bad.Hepatology,2016,63(6):2019-2031.
[16]Cadranel JF,Garioud A,Nousbaum JB,et al.Benefit of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding in real life.Eur J Gastroenterol Hepatol,2015,27(2):183-184.
[17]Moon AM,Dominitz JA,Ioannou GN,et al.Use of antibiotics among patients with cirrhosis and upper gastrointestinal bleeding is associated with reduced mortality.Clin Gastroenterol Hepatol,2016,14(11):1629-1637.
[18]杨兴平,陈和平.预防性应用头孢曲松钠对肝硬化上消化道出血患者感染的影响.实用肝脏病杂志,2017,20(3):362-363.
[19]Hyuck Lee.Procalcitonin as a biomarker of infectious diseases.Korean J Intern Med,2013,28:285-291.
[20]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识.中华急诊医学杂志,2012,21(9):944-954.
[21]王立,盛吉芳,郑春华,等.血清降钙素原与内毒素对肝硬化患者腹水感染的诊断分析.中华医院感染学杂志,2016,26(1):43-45.
[2]Watts MR,Gupta V,Liddle C.Antimicrobials in cirrhotic patients after upper gastrointestinal hemorrhage:One size no longer fits all.Clin Gastroenterol Hepatol,2016,14(2):324-325.
[3]郝勇,谭萍,赵亚刚,等.肝硬化食管胃底静脉曲张出血患者预防性抗菌治疗的前瞻性研究.实用肝脏病杂志,2012,15(1):29-31.
[4]Restellini S,Nendaz M,Morard I.Antibiotic prophylaxis in liver cirrhosis.Rev Med Suisse,2012,8(326):276-281.
[5]中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[6]中华人民共和国卫生部.医院感染诊断标准.北京:中华人民共和国卫生部,2009:119-125.
[7]Garcia TG.Current management of the complications of cirrhosis and portal hypertension:Variceal hemorrhage,ascites,and spontaneous bacterial peritonitis.Dig Dis,2016,34(4):382-386.
[8]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.中华医院感染学杂志,2015,25(1):169-170.
[9]Mouelhi L,Ayadi H,Zaimi Y,et al.Predictive scores of early mortality from variceal gastrointestinal bleeding in cirrhotic patients.Tunis Med,2016,94(11):670-676.
[10]Noveloso B,Bastiampillai B,Perni N,et al.Antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding.Am Fam Physician,2017,95(9):582-588.
[11]张晓亮.某院革兰阴性杆菌对美罗培南与亚胺培南体外敏感性比较.中国医院药学杂志,2015,35(5):447-449.
[12]魏丽荣,刘景院,宋丽红.肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况.中华实验和临床感染病杂志(电子版),2013,7(3):71-74.
[13]张鹏亮,徐修礼,白露.医院感染大肠埃希菌及肺炎克雷伯菌的产酶率与耐药性分析.中华医院感染学杂志,2015,25(3):508-510.
[14]Thevenot T,Degand T,Grelat N,et al.A French national survey on the use of antibiotic prophylaxis in cirrhotic patients.Liver Int,2013,33(3):389-397.
[15]Fernández J,Tandon P,Mensa J,et al.Antibiotic prophylaxis in cirrhosis:Good and bad.Hepatology,2016,63(6):2019-2031.
[16]Cadranel JF,Garioud A,Nousbaum JB,et al.Benefit of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding in real life.Eur J Gastroenterol Hepatol,2015,27(2):183-184.
[17]Moon AM,Dominitz JA,Ioannou GN,et al.Use of antibiotics among patients with cirrhosis and upper gastrointestinal bleeding is associated with reduced mortality.Clin Gastroenterol Hepatol,2016,14(11):1629-1637.
[18]杨兴平,陈和平.预防性应用头孢曲松钠对肝硬化上消化道出血患者感染的影响.实用肝脏病杂志,2017,20(3):362-363.
[19]Hyuck Lee.Procalcitonin as a biomarker of infectious diseases.Korean J Intern Med,2013,28:285-291.
[20]降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识.中华急诊医学杂志,2012,21(9):944-954.
[21]王立,盛吉芳,郑春华,等.血清降钙素原与内毒素对肝硬化患者腹水感染的诊断分析.中华医院感染学杂志,2016,26(1):43-45.