肝硬化腹水患者合并自发性细菌性腹膜炎时血管性假性血友病因子的临床研究
发布时间：2018-07-13 16:57
【摘要】：目的:通过比较乙肝肝硬化腹水患者中是否合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP),以及合并SBP的患者治疗前后血浆血管性假性血友病因子(von willebrand factor,v WF)水平,探索v WF在肝硬化腹水患者合并自发性细菌性腹膜炎时的诊断价值及是否可以作为潜在的治疗目标。方法:1.本研究全部数据都采用从2015年7月至2016年12月于重庆医科大学附属第二医院感染科的住院患者中年龄在18岁至65岁之间,临床诊断为乙肝肝硬化的病人中,入院后48小时内完善肝功、凝血象、血图分析、降钙素原,电解质肾功并于住院期间完善腹水定位或者腹部彩超、部分病人有腹水常规及腹水培养等,患者知情、并签订同意书留置血液标本供实验用。经收集后共获得204位患者信息及血液标本,作为初筛的实验数据来源。根据影响血浆v WF的其他影响因素同时排除肝功能受损严重的肝衰竭患者制定以下排除标准进一步筛选:合并其他原因所致急、慢性肝病;临床症状、体征及实验室检查提示肝功能衰竭患者;已明确或者可疑合并腹腔外感染,入我院治疗前已使用抗生素抗感染治疗,入我院后经抗感染治疗2周后自发性腹膜炎仍未得到有效控制患者;合并心血管系统疾病、糖尿病、高脂血症、肿瘤、出凝血性疾病及近2周有抗血小板或抗凝药物服用史。最终获得92例病例资料,其中男性61例、女性31例。患者在知情,并签订同意书的前提下搜集研究对象的临床资料,其中包括年龄、性别、血清白蛋白、总胆红素、凝血酶原时间、腹水定性及定量、腹水检查、腹水培养,及通过ELISA测得的血浆v WF水平。2.数据收集完毕后开始进行统计学分析,根据是否合并腹水、是否在腹水基础上合并SBP进行分组:A组为乙肝肝硬化无腹水患者(不合并SBP),B组为乙肝肝硬化腹水不合并SBP患者,C组为乙肝肝硬化腹水合并SBP患者共三组。组间比较采用单因素方差分析;同时对C组病人抗感染治疗前后血浆v WF水平进行比较,采用配对t检验。结果:1.乙肝肝硬化腹水合并SBP患者的血浆v WF水平(2741.18±651.35)明显高于乙肝肝硬化腹水未合并SBP患者(2022.70±527.41),差异有统计学意义(P0.001);在均不合并SBP的情况下,乙肝肝硬化有腹水患者的血浆v WF水平(2022.70±527.41)明显高于乙肝肝硬化患者无腹水患者(1462.41±323.62),差异具有统计学意义(P=0.004)。2.乙肝肝硬化合并腹水及SBP患者通过对有效抗感染治疗前后血浆v WF水平比较发现,血浆v WF水平由治疗前(2741.18±651.35)降为治疗后(2197.52±562.70),差异具有统计学意义(P0.001)。结论:乙肝肝硬化腹水患者中,合并SBP患者血浆v WF水平明显高于无SBP患者,且合并SBP患者经有效的抗感染治疗好转后血浆v WF水平较治疗前明显下降。血浆v WF水平对肝硬化腹水患者是否合并SBP有一定的诊断价值,可能成为潜在的治疗目标。
[Abstract]:Objective: to compare the levels of plasma von Willebrand factor (von willebrand factor v WF) in patients with hepatitis B cirrhosis and ascites with spontaneous bacterial peritonitis (spontaneous bacterial peritoneal peritonitis) before and after treatment. To explore the diagnostic value of v WF in cirrhotic ascites patients with spontaneous bacterial peritonitis and whether it can be used as a potential therapeutic target. Method 1: 1. From July 2015 to December 2016, all the data were used among the patients aged between 18 and 65 years who were clinically diagnosed as hepatitis B cirrhosis in the infection Department of the second affiliated Hospital of Chongqing Medical University. Within 48 hours after admission, liver function, coagulation, blood analysis, procalcitonin, electrolytes and renal function were improved during hospitalization. Some patients had ascites routine and ascites culture. And sign the consent to keep blood samples for the experiment. A total of 204 patient information and blood samples were collected and used as the experimental data source for primary screening. According to other influencing factors affecting plasma v WF and excluding liver failure patients whose liver function is seriously impaired, the following exclusion criteria were established: acute liver disease complicated with other causes, chronic liver disease, clinical symptoms, The signs and laboratory examination indicated that the patients with liver failure had definite or suspicious extraperitoneal infection and had been treated with antibiotics before entering our hospital. The patients with spontaneous peritonitis were not effectively controlled after 2 weeks of anti-infection treatment, and had cardiovascular diseases, diabetes mellitus, hyperlipidemia, tumor, bleeding disease and antiplatelet or anticoagulant medication in the last 2 weeks. Finally, 92 cases were obtained, including 61 males and 31 females. The patients were informed and signed a consent letter to collect the clinical data of the subjects, including age, sex, serum albumin, total bilirubin, prothrombin time, ascitic fluid qualitative and quantitative analysis, ascites examination, ascites culture. And the plasma v WF level measured by Elisa. After the data collection was completed, statistical analysis was carried out, according to whether ascites were merged, Whether to combine SBP with ascites on the basis of ascites was divided into three groups: group 1: group A: hepatitis B cirrhosis without ascites (without SBP) group B: hepatitis B cirrhosis ascites not complicated with SBP group C group: hepatitis B cirrhosis ascites with SBP group. Univariate ANOVA was used to compare the plasma vWF levels before and after anti-infective therapy in group C, and paired t test was used to compare the plasma vWF levels before and after anti-infective therapy. The result is 1: 1. The plasma vWF levels in patients with hepatitis B cirrhosis ascites complicated with SBP (2741.18 卤651.35) were significantly higher than those in patients without hepatitis B cirrhosis ascites (2022.70 卤527.41), the difference was statistically significant (P0.001). The plasma vWF levels in patients with ascites (2022.70 卤527.41) were significantly higher than that in patients without ascites (1462.41 卤323.62). The difference was statistically significant (P0. 004). The plasma vWF levels in patients with hepatitis B cirrhosis complicated with ascites and SBP before and after effective anti-infective therapy were compared. It was found that the plasma vWF levels decreased from (2741.18 卤651.35) to (2197.52 卤562.70) before and after treatment, and the difference was statistically significant (P0.001). Conclusion: in patients with hepatitis B cirrhosis ascites, the plasma vWF level in patients with SBP is significantly higher than that in patients without SBP, and the level of vWF in patients with SBP after effective anti-infection therapy is significantly lower than that in patients without SBP. Plasma v WF level may be a potential target for the diagnosis of cirrhotic ascites with SBP.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R512.62;R572.2
本文编号：2120103
[Abstract]:Objective: to compare the levels of plasma von Willebrand factor (von willebrand factor v WF) in patients with hepatitis B cirrhosis and ascites with spontaneous bacterial peritonitis (spontaneous bacterial peritoneal peritonitis) before and after treatment. To explore the diagnostic value of v WF in cirrhotic ascites patients with spontaneous bacterial peritonitis and whether it can be used as a potential therapeutic target. Method 1: 1. From July 2015 to December 2016, all the data were used among the patients aged between 18 and 65 years who were clinically diagnosed as hepatitis B cirrhosis in the infection Department of the second affiliated Hospital of Chongqing Medical University. Within 48 hours after admission, liver function, coagulation, blood analysis, procalcitonin, electrolytes and renal function were improved during hospitalization. Some patients had ascites routine and ascites culture. And sign the consent to keep blood samples for the experiment. A total of 204 patient information and blood samples were collected and used as the experimental data source for primary screening. According to other influencing factors affecting plasma v WF and excluding liver failure patients whose liver function is seriously impaired, the following exclusion criteria were established: acute liver disease complicated with other causes, chronic liver disease, clinical symptoms, The signs and laboratory examination indicated that the patients with liver failure had definite or suspicious extraperitoneal infection and had been treated with antibiotics before entering our hospital. The patients with spontaneous peritonitis were not effectively controlled after 2 weeks of anti-infection treatment, and had cardiovascular diseases, diabetes mellitus, hyperlipidemia, tumor, bleeding disease and antiplatelet or anticoagulant medication in the last 2 weeks. Finally, 92 cases were obtained, including 61 males and 31 females. The patients were informed and signed a consent letter to collect the clinical data of the subjects, including age, sex, serum albumin, total bilirubin, prothrombin time, ascitic fluid qualitative and quantitative analysis, ascites examination, ascites culture. And the plasma v WF level measured by Elisa. After the data collection was completed, statistical analysis was carried out, according to whether ascites were merged, Whether to combine SBP with ascites on the basis of ascites was divided into three groups: group 1: group A: hepatitis B cirrhosis without ascites (without SBP) group B: hepatitis B cirrhosis ascites not complicated with SBP group C group: hepatitis B cirrhosis ascites with SBP group. Univariate ANOVA was used to compare the plasma vWF levels before and after anti-infective therapy in group C, and paired t test was used to compare the plasma vWF levels before and after anti-infective therapy. The result is 1: 1. The plasma vWF levels in patients with hepatitis B cirrhosis ascites complicated with SBP (2741.18 卤651.35) were significantly higher than those in patients without hepatitis B cirrhosis ascites (2022.70 卤527.41), the difference was statistically significant (P0.001). The plasma vWF levels in patients with ascites (2022.70 卤527.41) were significantly higher than that in patients without ascites (1462.41 卤323.62). The difference was statistically significant (P0. 004). The plasma vWF levels in patients with hepatitis B cirrhosis complicated with ascites and SBP before and after effective anti-infective therapy were compared. It was found that the plasma vWF levels decreased from (2741.18 卤651.35) to (2197.52 卤562.70) before and after treatment, and the difference was statistically significant (P0.001). Conclusion: in patients with hepatitis B cirrhosis ascites, the plasma vWF level in patients with SBP is significantly higher than that in patients without SBP, and the level of vWF in patients with SBP after effective anti-infection therapy is significantly lower than that in patients without SBP. Plasma v WF level may be a potential target for the diagnosis of cirrhotic ascites with SBP.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R512.62;R572.2
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相关期刊论文 前4条
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