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

陈金强; 李春达; 李富强; 陆利明; 方斌; 金智华

doi:10.16766/j.cnki.issn.1674-4152.002003

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

doi: 10.16766/j.cnki.issn.1674-4152.002003

绍兴市中心医院感染科，浙江绍兴 312030

基金项目:

浙江省医药卫生科技计划项目 2020KY990

详细信息

通讯作者:
金智华，E-mail：523483543@qq.com

中图分类号: R575.2 R572.2
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出版历程
- 收稿日期: 2020-09-09
- 网络出版日期: 2022-02-16

Analysis and treatment of the risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis

Department of Infectious Diseases, Shaoxing Central Hospital, Shaoxing, Zhejiang 312030, China

摘要

摘要: 目的探讨肝硬化失代偿期患者并发自发性腹膜炎(spontaneous peritonitis，SBP)的危险因素及治疗方法。方法回顾性选择2011年1月—2019年12月在绍兴市中心医院接受诊治的肝硬化失代偿期患者120例，按是否并发自发性腹膜炎将其分为并发组和未并发组，各60例，采用logistic回归分析研究影响肝硬化失代偿期患者并发自发性腹膜炎的危险因素。根据治疗药物的不同将并发组分为哌拉西林舒巴坦组和头孢曲松组，各30例，比较2组临床疗效、炎症因子水平。结果单因素分析显示，消化道出血、SBP既往史、Child-Pugh改良分级评分(Child-Turcotte Pugh score)、总胆红素水平、血钠水平对肝硬化失代偿期患者并发自发性腹膜炎有一定影响(均P < 0.05)。多因素分析显示，消化道出血、Child-Pugh改良分级评分、总胆红素水平是肝硬化失代偿期患者并发自发性腹膜炎的独立危险因素(OR=0.191、0.259、0.922，均P < 0.05)。治疗后，哌拉西林舒巴坦组治疗总有效率明显高于头孢曲松组(P < 0.05)；2组血清降钙素原(PCT)、C-反应蛋白(CRP)水平均明显低于治疗前(均P < 0.05)，且哌拉西林舒巴坦组均明显低于头孢曲松组(均P < 0.05)。结论消化道出血、Child-Pugh高分级、高总胆红素水平是肝硬化失代偿期患者并发自发性腹膜炎的独立危险因素。哌拉西林舒巴坦治疗自发性腹膜炎的临床疗效显著，可有效减轻机体炎症反应。
- 肝硬化 /
- 失代偿期 /
- 自发性腹膜炎 /
- /
- 哌拉西林舒巴坦
Abstract: Objective To explore the risk factors and treatment of spontaneous peritonitis in patients with decompensated liver cirrhosis. Methods A total of 120 patients with decompensated liver cirrhosis who were treated in our hospital from January 2011 to December 2019 were divided into the concurrent group and non-complicated group based on whether they were complicated by spontaneous peritonitis (60 cases in each group). Logistic regression analysis was used to analyse the risk factors of spontaneous peritonitis in patients with decompensated liver cirrhosis. According to the different treatment drugs, the concurrent components were divided into the piperacillin and sulbactam group and ceftriaxone group (30 cases in each group). The clinical efficacy and inflammatory factor levels of the two groups were compared. Results Univariate analysis showed that the incidence of gastrointestinal bleeding, past history of SBP, Child-Pugh classification, total bilirubin level and blood sodium level had a certain effect on patients with decompensated liver cirrhosis complicated with spontaneous peritonitis (all P < 0.05). Multivariate analysis showed that gastrointestinal bleeding, Child-Pugh classification and total bilirubin levels were independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis (OR=0.191, 0.259, 0.922, all P < 0.05). The total effective rate of treatment in the piperacillin and sulbactam group was apparently higher than that in the ceftriaxone group (P < 0.05). After treatment, the levels of serum procalcitonin and C-reactive protein in the two groups were significantly lower than those before treatment (all P < 0.05), and the levels in the piperacillin and sulbactam group were apparently lower than those in the ceftriaxone group (all P < 0.05). Conclusion Gastrointestinal bleeding, high Child-Pugh grade and high total bilirubin levels are independent risk factors for spontaneous peritonitis in patients with decompensated liver cirrhosis. Piperacillin and sulbactam can be used in patients with spontaneous peritonitis to reduce the level of inflammatory factors in the body.
- Liver cirrhosis /
- Decompensated period /
- Spontaneous peritonitis /
- Risk factors /
- Piperacillin and sulbactam

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表 1 肝硬化失代偿期患者并发自发性腹膜炎的单因素分析(例)

组别	例数	性别		年龄(x±s，岁)	糖尿病		消化道出血		肝性脑病		SBP既往史		Child-Pugh改良分级评分(分)		总胆红素(x±s，μmmol/L)	血钠(x±s，mmol/L)
组别	例数	男性	女性	年龄(x±s，岁)	是	否	是	否	是	否	是	否	≥9	< 9	总胆红素(x±s，μmmol/L)	血钠(x±s，mmol/L)
并发组	60	45	15	56.70±10.68	16	44	49	11	10	50	14	46	38	22	69.42±19.36	127.30±15.44
未并发组	60	48	12	57.38±9.42	18	42	35	25	8	52	5	55	15	45	40.83±15.41	134.41±14.85
统计量		0.430^a		-0.372^b	0.164^a		8.044^a		0.261^a		5.065^a		18.639^a		8.950^b	-2.568^b
P值		0.512		0.711	0.685		0.005		0.609		0.024		＜0.001		＜0.001	0.011
注：^a为χ²值，^b为t值。

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表 2 肝硬化失代偿期并发自发性腹膜炎危险因素的变量赋值说明

变量	相关因素	赋值
X1	消化道出血	是=1，否=0
X2	Child-Pugh改良分级评分	≥9分=1， < 9分=0
X4	SBP既往史	是=1，否=0
X3	总胆红素	连续型变量
X5	血钠	连续型变量
Y	肝硬化失代偿期并发自发性腹膜炎	是=1，否=0

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表 3 肝硬化失代偿期患者并发自发性腹膜炎的多因素分析

项目	B	SE	Wald χ²	P值	OR(95% CI)
消化道出血	-1.654	0.684	5.842	0.016	0.191(0.050~0.731)
Child-Pugh改良分级评分	-1.352	0.630	4.604	0.032	0.259(0.075~0.890)
总胆红素	-0.081	0.017	23.471	＜0.001	0.922(0.892~0.953)

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表 4 不同药物治疗肝硬化失代偿期患者并发自发性腹膜炎的总有效率比较[例(%)]

组别	例数	显效	有效	无效	总有效
哌拉西林舒巴坦组	30	16(53.33)	12(40.00)	2(6.67)	28(93.33)
头孢曲松组	30	9(30.00)	13(43.33)	8(26.67)	22(73.33)
注：2组总有效率比较，χ²=4.320，P=0.038。

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表 5 不同药物对肝硬化失代偿期患者并发自发性腹膜炎炎症因子的影响(x ±s)

组别	例数	PCT(μg/L)		CRP(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
哌拉西林舒巴坦组	30	2.34±0.57	0.45±0.10^a	52.62±8.42	18.23±3.45^a
头孢曲松组	30	2.46±0.48	0.95±0.23^a	51.74±7.63	27.62±4.58^a
t值		-0.882	-10.920	0.424	-8.969
P值		0.381	＜0.001	0.673	＜0.001
注：与治疗前比较，^aP < 0.05。

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