慢加急性肝衰竭患者乳果糖及质子泵抑制剂的应用和原发性腹膜炎的关系

发布时间：2018-07-12 17:33

本文选题：慢加急性肝衰竭 + 慢性乙型肝炎　；参考：《重庆医科大学》2013年硕士论文

【摘要】：背景目前认为的原发性腹膜炎主要发生机制是肠道细菌的过度生长及移位。而乳果糖的应用可以明显增强肠道沙门氏菌的移位，质子泵抑制剂（PPI）可以通过抑制胃酸的分泌而增加消化道细菌的定植，并在综合其它因素后使细菌移位变得更加容易。故本文旨在探索慢性乙型肝炎（CHB）基础上的慢加急性肝衰竭（ACLF）患者中乳果糖及PPI的应用是否和原发性腹膜炎（SBP）的发生具有相关性。方法入选了重庆医科大学附二院2005年1月到2010年12月期间住院的CHB基础上的ACLF患者进行回顾性病例对照研究，符合标准的总共118例。收集分析了这些患者的人口统计学及临床资料，并探索ACLF患者SBP发生的可能的危险因素。入院后发生SBP的病例组和没有发生SBP的对照组1:1频数匹配（59vs59）。同时也对纳入病例的预后进行了分析。Logistic回归分析用来控制混杂因素从而确定发生SBP的危险因素。结果在病例组中发生SBP前乳果糖的应用比率比对照组高，且差异有统计学意义（55.9%vs.28.8%, p=0.005），PPI的应用也有相似结果，两组差异也具有统计学意义（86.4%vs.67.8%, p=0.0273）。自动出院或死亡组中住院期间SBP发生的比率是65.0%，而好转出院组的SBP发生率为32.7%，差异有统计学意义（p=0.000）。病例组和对照组在性别、年龄及血浆国际标准化比率（INR）等方面没用显著性差异，，同样的，在发生SBP之前两组在乙型肝炎脱氧核糖核酸（HBV-DNA）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、白蛋白（ALB）及发生SBP前有无腹水等方面也没有显著性差异（P0.05）。在多因素Logistic回归分析中，ACLF患者中SBP的发生和PPI的应用是相关的（OR,2.564；95%CI,0.989-6.648; p=0.047），乳果糖的应用也和ACLF患者SBP的发生明显相关（OR,2.818;95%CI,1.294-6.136; p=0.008）。和已有的结论一样，SBP的发生和ACLF患者的预后密切相关（OR,0.257；95%CI,0.105-0.631; p=0.003）。这些ACLF患者中，预防性或治疗应用PPI的有78%的患者没有明确的使用PPI的指针。结论 CHB基础上的ACLF患者中，乳果糖及PPI应用和SBP的发生呈明显正相关。病程中SBP的发生也和自动出院或死亡不良结局也呈明显正相关。因此，合理地应用乳果糖或PPI显得十分重要，除了对已经发生的SBP要积极抗感染治疗外，尽早尽量减少SBP发生的风险也十分关键。仍需要前瞻性的双盲的随机对照研究进一步证明是否尽量避免应用乳果糖及PPI可以减少ACLF患者SBP的发生率，从而改善患者预后。
[Abstract]:Background the main mechanism of primary peritonitis is the overgrowth and translocation of intestinal bacteria. Proton pump inhibitor (PPI) can increase bacterial colonization of digestive tract by inhibiting gastric acid secretion, and make bacterial translocation easier after combining other factors. The purpose of this study was to explore whether the use of lactulose and PPI in patients with chronic hepatitis B (CHB) and acute hepatic failure (ACLF) is related to the occurrence of primary peritonitis (SBP). Methods A retrospective case-control study of patients with ACLF on the basis of CHB from January 2005 to December 2010 in the second affiliated Hospital of Chongqing Medical University was carried out. A total of 118 patients met the criteria. The demographic and clinical data of these patients were collected and analyzed, and the possible risk factors of SBP in patients with ACLF were explored. The 1:1 frequency matching (59vs59) was found in the patients with SBP after admission and in the control group without SBP. Logistic regression analysis was used to control the confounding factors to determine the risk factors of SBP. Results the application rate of pre-SBP fructose in the case group was higher than that in the control group, and the difference was statistically significant (55.9vs.28.8B, p0.005) the application of PPI was similar, and the difference between the two groups was statistically significant (86.4vs.67.8, p0.0273). The incidence rate of SBP during hospitalization was 65.0 in the group of automatic discharge or death, while the incidence of SBP in the group of improved discharge was 32.70.The difference was statistically significant (p0.000). There was no significant difference in sex, age and plasma international standardized ratio (INR) between the case group and the control group. There was no significant difference between the two groups in hepatitis B deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (alt), aspartate aminotransferase (AST), albumin (ALB) and ascites before SBP (P0.05). In multivariate logistic regression analysis, the occurrence of SBP and the use of PPI in ACLF patients were correlated (OR2. 564 / 95CII 0.989-6.648; p0. 047). The use of lactulose was also significantly correlated with the occurrence of SBP in patients with ACLF (OR2.81895CI1.294-6.136; p0.008). The occurrence of SBP was closely related to the prognosis of patients with ACLF (Orr 0.257 ~ 95CII 0.105-0.631; p0.003). Of these ACLF patients, 78% did not have a definite PPI pointer for prophylactic or therapeutic use of PPI. Conclusion in patients with ACLF based on CHB, the use of lactulose and PPI is positively correlated with the occurrence of SBP. The occurrence of SBP was also positively correlated with the adverse outcome of discharge or death. Therefore, it is very important to use lactilose or PPI rationally. Besides the active anti-infection treatment of SBP, it is also very important to reduce the risk of SBP as early as possible. A prospective double-blind randomized controlled study was still needed to further demonstrate whether avoiding the use of lactulose and PPI could reduce the incidence of SBP in patients with ACLF and thus improve the prognosis of patients with ACLF.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R575.3;R572.2

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