诊断肝硬化并发自发性腹膜炎的有利因素分析

发布时间：2019-01-16 03:51

【摘要】：目的：肝硬化并发自发性腹膜炎（spontaneous bacterial peritonitis，SBP)的发病率和死亡率特别高，肝硬化并发SBP的患者尤其是只有症状、体征但腹水培养、腹水白细胞都阴性的SBP患者，在临床中容易被漏诊、误诊。该文章旨在分析诊断肝硬化并发SBP的有利因素，以加强对该疾病的认识和诊治能力、降低该疾病的死亡率，帮助患者改善不良的预后。方法：选取2012年1月至2013年9月期间在吉大一院肝病科住院的114例肝硬化并发SBP患者，并随机选取同期住院的114例肝硬化腹水非SBP患者，回顾性分析两组患者的临床资料，分别选用单因素分析及多因素二元Logistic回归分析方法对两组患者的年龄、性别、病因、既往出血病史、既往腹水病史、血清生化检查、Child-Pugh分级、并发症进行比较，探讨诊断肝硬化并发SBP的有利因素。结果：（1）SBP组的114例患者，79例发热，38例腹痛，68例腹部压痛，37例腹部反跳痛，26例腹泻，20例腹部肌紧张。（2）SBP组的114例患者，78例腹水白细胞大于500×106/L，46例腹水中培养到致病菌，共得56株致病菌，其中有37株革兰阴性菌，19株革兰阳性菌，没有培养出真菌。（3）单因素分析显示，比较两组患者的既往腹水病史、TBIL、CHE、PT、PTA、WBC、NE%、Child-Pugh分级、肝性脑病、低钠血症，有统计学意义(P0.05)；在年龄、性别、病因、既往出血病史、AST、ALT、ALP、GGT、ALB、BUN、Cr、上消化道出血、肝肾综合征方面比较，没有统计学意义(P0.05)。（4）多因素分析提示，Child-Pugh分级高、既往有腹水史、高WBC水平是有利于诊断肝硬化并发SBP的独立相关因素。结论：（1）该研究中SBP组的患者，临床表现大多数不典型，最常见是发热、腹部压痛，其次是腹痛、反跳痛、腹泻、腹部肌紧张，对SBP的诊断有一定的提示作用。（2）该研究中SBP组的患者，致病菌仍多为革兰阴性菌,但革兰阳性菌的数量有所增加，，腹水细菌培养阳性率和腹水白细胞诊断SBP的敏感性都不高。（3）单因素分析提示，肝性脑病、低钠血症、既往腹水病史、TBIL、CHE、PT、PTA、WBC、NE%、Child-Pugh分级可能是有利于诊断肝硬化并发SBP的相关因素。（4）多因素二元logistic回归分析提示，高Child-Pugh分级、既往腹水病史、高WBC水平是有利于诊断肝硬化并发SBP的三个独立相关因素，即肝硬化患者存在高Child-Pugh分级或既往腹水病史或高腹水蛋白，更有利于诊断肝硬化并发SBP。（5）该研究的入选病例总数少，而且其他有意义的相关因素可能被遗漏，故进一步的研究应当着力注重回顾性研究的质量,采用多中心研究或肝硬化人群的前瞻性队列研究来增加研究结论的可信度。
[Abstract]:Objective: the incidence and death rate of cirrhosis complicated with spontaneous peritonitis (spontaneous bacterial peritonitis,SBP) is particularly high, especially in patients with liver cirrhosis complicated with SBP, especially in SBP patients with only symptoms, signs but ascites culture, and negative ascites leukocytes. It is easy to be missed and misdiagnosed in clinic. The purpose of this article is to analyze the favorable factors in the diagnosis of cirrhosis complicated with SBP, in order to strengthen the ability of understanding and diagnosis and treatment of the disease, reduce the mortality of the disease, and help the patients to improve the poor prognosis. Methods: from January 2012 to September 2013, 114 patients with liver cirrhosis complicated with SBP and 114 patients with cirrhosis and ascites without SBP were selected from January 2012 to September 2013. The clinical data of the two groups were analyzed retrospectively. Univariate analysis and multivariate Logistic regression analysis were used to compare the age, sex, etiology, bleeding history, ascites history, serum biochemical examination, Child-Pugh grading and complications between the two groups. To explore the favorable factors in diagnosis of cirrhosis complicated with SBP. Results: (1) in SBP group, there were 79 cases of fever, 38 cases of abdominal pain, 68 cases of abdominal tenderness, 37 cases of abdominal rebound pain, 26 cases of diarrhea and 20 cases of abdominal muscle tension. A total of 56 strains of pathogenic bacteria were isolated from 46 cases of ascites, of which 37 were Gram-negative bacteria and 19 were Gram-positive bacteria. (3) univariate analysis showed that the previous ascites history of the two groups was compared, TBIL,CHE,. PT,PTA,WBC,NE%,Child-Pugh grade, hepatic encephalopathy, hyponatremia, there was statistical significance (P0.05); There was no significant difference in age, sex, etiology, past bleeding history, AST,ALT,ALP,GGT,ALB,BUN,Cr, upper gastrointestinal bleeding and hepatorenal syndrome (P0.05). (4). High Child-Pugh grade, ascites history and high WBC level are independent factors in the diagnosis of cirrhosis complicated with SBP. Conclusion: (1) in the SBP group, the clinical manifestations were mostly atypical, the most common were fever, abdominal tenderness, followed by abdominal pain, rebound pain, diarrhea, abdominal muscle tension. (2) in the SBP group, the pathogenic bacteria were still Gram-negative bacteria, but the number of Gram-positive bacteria increased. (3) univariate analysis showed that hepatic encephalopathy, hyponatremia, ascites history, TBIL,CHE,PT,PTA,WBC,NE%, Child-Pugh grade may be helpful in the diagnosis of cirrhosis complicated with SBP. (4) Multivariate logistic regression analysis suggested that high Child-Pugh grade, previous ascites history, High WBC level is one of the three independent related factors in the diagnosis of liver cirrhosis complicated with SBP, that is, high Child-Pugh grade, previous ascites history or high ascites protein in patients with liver cirrhosis. It is more helpful to diagnose cirrhosis complicated with SBP. (5) the total number of selected cases in this study is small, and other significant related factors may be omitted, so further research should focus on the quality of retrospective study. A multicenter study or prospective cohort study of cirrhotic people was used to increase the reliability of the findings.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R656.41

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