乙型肝炎肝硬化并发自发性肠球菌性腹膜炎的临床特征及其影响因素

摘要/Abstract

摘要： 目的探讨乙型肝炎肝硬化并发自发性肠球菌性腹膜炎的临床特征及其影响因素。方法纳入2018年7月至2023年3月张家港澳洋医院收治的120例乙型肝炎肝硬化患者,其中并发自发性肠球菌性腹膜炎55例为并发组,另65例为非并发组。比较两组临床特征,分析乙型肝炎肝硬化并发自发性肠球菌性腹膜炎的危险因素。结果并发组患者消化道出血、既往接受过抗菌药物治疗、存在腹部手术史分别为18例(32.7%)、47例(85.5%)、24例(43.6%),高于非并发组的8例(12.3%)、32例(49.2%)、5例(7.7%)。白蛋白、肌酐水平分别为(29.5±3.6)g/L、(95.7±9.4)μmol/L,低于非并发组的(32.9±4.3)g/L、(121.7±11.8)μmol/L(P<0.05)。多因素logistic回归分析发现,消化道出血、既往接受过抗菌药物治疗、存在腹部手术史及低白蛋白、低肌酐均为乙型肝炎肝硬化患者并发自发性肠球菌性腹膜炎的危险因素(OR=4.721、4.623、5.013、5.286、5.124,P<0.05)。结论乙型肝炎肝硬化患者合并自发性肠球菌性腹膜炎的风险较高。

关键词: 乙型肝炎肝硬化, 自发性肠球菌性腹膜炎, 临床特征, 影响因素

Abstract: Objective To explore the clinical characteristics of hepatitis B-related cirrhosis complicated by spontaneous enterococcus peritonitis (SEP), and analyze the influencing factors of the complication. Methods From July 2018 to March 2023, 120 patients were admitted with hepatitis B related cirrhosis. Among them, 55 patients complicated with SEP were classified as concurrent group, and the remaining 65 patients were classified as non-concurrent group. The clinical characteristics of patients in these two groups were compared, and the risk factors of SEP in hepatitis B-related cirrhosis were analyzed. Results The proportion of gastrointestinal bleeding, previous treatment with antibiotics, and history of abdominal surgery in the concurrent group was 32.7%, 85.5%, and 43.6%, respectively, which were higher than those in the non-concurrent group (12.3%, 49.2%, and 7.7%); The levels of albumin and creatinine were (29.5 ± 3.6) g/L and (95.7 ± 9.4) respectively μmol/L, lower than the non-concurrent group [(32.9 ± 4.3) g/L, (121.7 ± 11.8) μmol/L, P<0.05]. By multivariate logistic regression analysis it was found that gastrointestinal bleeding, previous antimicrobial treatment, history of abdominal surgery, low albumin and low creatinine were all risk factors for SEP in hepatitis B-related cirrhosis patients (OR=4.721, 4.623, 5.013, 5.286, 5.124, P<0.05). Conclusion The risk of SEP in hepatitis B-related cirrhosis is high,with gastrointestinal bleeding, history of antimicrobial treatment, abdominal surgery, and low levels of albumin and creatinine as the risk factors, which warrant clinical attention.

Key words: Hepatitis B-related cirrhosis, Spontaneous enterococcus peritonitis, Clinical characteristics, Influencing factors

汤亚君, 单亚林. 乙型肝炎肝硬化并发自发性肠球菌性腹膜炎的临床特征及其影响因素[J]. 肝脏, 2024, 29(5): 508-511.

TANG Ya-jun, SHAN Ya-lin. Clinical features and influencing factors of hepatitis B-related cirrhosis complicated by spontaneous enterococcal peritonitis[J]. Chinese Hepatolgy, 2024, 29(5): 508-511.

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参考文献

[1] Mohamed AA, Al-Karmalawy AA, El-Kholy AA, et al. Effect of vitamin D supplementation in patients with liver cirrhosis having spontaneous bacterial peritonitis: a randomized controlled study[J]. Eur Rev Med Pharmacol Sci, 2021, 25(22): 6908-6919.
[2] Caturano A, Brunelli V, Galiero R, et al. Comment on: effect of vitamin D supplementation in patients with liver cirrhosis having spontaneous bacterial peritonitis: a randomized controlled study[J]. Eur Rev Med Pharmacol Sci, 2022, 26(7): 2220-2221.
[3] Falleti E, Cmet S, Cussigh AR, et al. Recurrent and treatment-unresponsive spontaneous bacterial peritonitis worsens survival in decompensated liver cirrhosis[J]. J Clin Exp Hepatol, 2021, 11(3): 334-342.
[4] ELshamy RM, Oda MS, Saeed MA, et al. A comparative study on nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis at a university hospital[J]. Eur J Gastroenterol Hepatol, 2022, 34(6): 655-663.
[5] 刘玉玲, 甄增国, 王慧娟, 等. 益生菌制剂对肝硬化并发自发性细菌性腹膜炎患者肠道屏障功能的影响[J]. 实用肝脏病杂志, 2021, 24(6): 867-870.
[6] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志, 2019, 27(11): 846-865.
[7] Bello KE, Irekeola AA, Al-Mhanna SB, et al. Prevalence of spontaneous bacterial peritonitis in hepatitis B, and hepatitis C liver cirrhosis: a systematic review and meta-analysis[J]. Healthcare (Basel), 2023, 11(2): 275.
[8] Würstle S, Hapfelmeier A, Karapetyan S, et al. Differentiation of spontaneous bacterial peritonitis from secondary peritonitis in patients with liver cirrhosis: retrospective multicentre study[J]. Diagnostics (Basel), 2023, 13(5): 994.
[9] Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(2): 1014-1048.
[10] Zhang M, Liu W, Xu X, et al. Association between proton pump inhibitor therapy and spontaneous bacterial peritonitis occurrence in cirrhotic patients: a clinical review[J]. Curr Med Sci, 2022, 42(4): 673-680.
[11] 杨晓薇, 伍沁芳, 汤金萍, 等. 基于肠道分子微生态系统平衡防治肝硬化自发性腹膜炎的研究[J]. 检验医学与临床, 2022, 19(23): 3199-3201, 3205.
[12] Popoiag RE, Suceveanu AI, Suceveanu AP, et al. Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil-to-lymphocyte ratio[J]. Exp Ther Med, 2021, 22(3): 983.
[13] Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(8): 587-598.
[14] 陈金强, 李春达, 李富强, 等. 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[J]. 中华全科医学, 2021, 19(7): 1131-1134.
[15] Fouad TR, Abdelsameea E, Abdel-Razek W, et al. Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post-therapeutic outcome and prognostic indicators[J]. J Gastroenterol Hepatol, 2019, 34(9): 1604-1610.
[16] Bajaj JS, Rodriguez MP, Fagan A, et al. Impact of bacterial infections and spontaneous bacterial peritonitis prophylaxis on phage-bacterial dynamics in cirrhosis[J]. Hepatology, 2022, 76(6): 1723-1734.
[17] Mittal H, Wyawahare M, Sistla S. Microbiological profile of pathogens in spontaneous bacterial peritonitis secondary to liver cirrhosis: a retrospective study[J]. Trop Doct, 2020, 50(2): 138-141.
[18] 孙小丹, 吕倩, 张倩. 肝硬化腹水合并自发性腹膜炎的抗感染治疗及对肠道菌群的影响[J]. 现代消化及介入诊疗, 2022, 27(11): 1456-1459.
[19] Fernández J, Angeli P, Trebicka J, et al. Efficacy of albumin treatment for patients with cirrhosis and infections unrelated to spontaneous bacterial peritonitis[J]. Clin Gastroenterol Hepatol, 2020, 18(4): 963-973.
[20] 江萍, 豆仁成, 崔子瑾, 等. 白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2097-2101.