診斷肝硬化并發(fā)自發(fā)性腹膜炎的有利因素分析
發(fā)布時間：2019-01-16 03:51
【摘要】：目的：肝硬化并發(fā)自發(fā)性腹膜炎（spontaneous bacterial peritonitis，SBP)的發(fā)病率和死亡率特別高，肝硬化并發(fā)SBP的患者尤其是只有癥狀、體征但腹水培養(yǎng)、腹水白細胞都陰性的SBP患者，在臨床中容易被漏診、誤診。該文章旨在分析診斷肝硬化并發(fā)SBP的有利因素，以加強對該疾病的認識和診治能力、降低該疾病的死亡率，幫助患者改善不良的預(yù)后。 方法：選取2012年1月至2013年9月期間在吉大一院肝病科住院的114例肝硬化并發(fā)SBP患者，并隨機選取同期住院的114例肝硬化腹水非SBP患者，回顧性分析兩組患者的臨床資料，分別選用單因素分析及多因素二元Logistic回歸分析方法對兩組患者的年齡、性別、病因、既往出血病史、既往腹水病史、血清生化檢查、Child-Pugh分級、并發(fā)癥進行比較，探討診斷肝硬化并發(fā)SBP的有利因素。 結(jié)果：（1）SBP組的114例患者，79例發(fā)熱，38例腹痛，68例腹部壓痛，37例腹部反跳痛，26例腹瀉，20例腹部肌緊張。（2）SBP組的114例患者，78例腹水白細胞大于500×106/L，46例腹水中培養(yǎng)到致病菌，共得56株致病菌，其中有37株革蘭陰性菌，19株革蘭陽性菌，沒有培養(yǎng)出真菌。（3）單因素分析顯示，比較兩組患者的既往腹水病史、TBIL、CHE、PT、PTA、WBC、NE%、Child-Pugh分級、肝性腦病、低鈉血癥，有統(tǒng)計學(xué)意義(P0.05)；在年齡、性別、病因、既往出血病史、AST、ALT、ALP、GGT、ALB、BUN、Cr、上消化道出血、肝腎綜合征方面比較，沒有統(tǒng)計學(xué)意義(P0.05)。（4）多因素分析提示，Child-Pugh分級高、既往有腹水史、高WBC水平是有利于診斷肝硬化并發(fā)SBP的獨立相關(guān)因素。 結(jié)論：（1）該研究中SBP組的患者，臨床表現(xiàn)大多數(shù)不典型，最常見是發(fā)熱、腹部壓痛，其次是腹痛、反跳痛、腹瀉、腹部肌緊張，對SBP的診斷有一定的提示作用。（2）該研究中SBP組的患者，致病菌仍多為革蘭陰性菌,但革蘭陽性菌的數(shù)量有所增加，，腹水細菌培養(yǎng)陽性率和腹水白細胞診斷SBP的敏感性都不高。（3）單因素分析提示，肝性腦病、低鈉血癥、既往腹水病史、TBIL、CHE、PT、PTA、WBC、NE%、Child-Pugh分級可能是有利于診斷肝硬化并發(fā)SBP的相關(guān)因素。（4）多因素二元logistic回歸分析提示，高Child-Pugh分級、既往腹水病史、高WBC水平是有利于診斷肝硬化并發(fā)SBP的三個獨立相關(guān)因素，即肝硬化患者存在高Child-Pugh分級或既往腹水病史或高腹水蛋白，更有利于診斷肝硬化并發(fā)SBP。（5）該研究的入選病例總數(shù)少，而且其他有意義的相關(guān)因素可能被遺漏，故進一步的研究應(yīng)當(dāng)著力注重回顧性研究的質(zhì)量,采用多中心研究或肝硬化人群的前瞻性隊列研究來增加研究結(jié)論的可信度。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2;R656.41
本文編號：2409432
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2;R656.41
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