HBV相关慢加急性肝衰竭患者并发细菌感染影响因素及预后结局分析

摘要/Abstract

摘要： 目的探讨HBV相关慢加急性肝衰竭(HBV-ACLF)患者并发细菌感染(BI)的影响因素及预后。方法选择南通大学附属台东医院2016年1月至2021年4月收治的HBV-ACLF患者128例。符合以下任一项即为BI:自发性细菌性腹膜炎、肺部感染、胆道感染及尿路感染。根据资料类型,采用t检验、卡方检验或秩和检验比较;多因素logistic回归分析HBV-ACLF患者并发BI的影响因素。结果 128例HBV-ACLF患者中未并发BI 24例,并发BI 104例。非BI组患者预防性使用抗生素、肝性脑病、静脉曲张出血及低钠血症分别为7例(29.2%)、3例(12.5%)、2例(8.3%)及4例(16.7%),BI组分别为13例(15.5%)、42例(40.4%)、28例(26.9%)及57例(54.8%),差异均有统计学意义(P<0.05);非BI组WBC、PLT、Alb、TBil、Cr、血清钠、INR及MELD评分分别为5.3(4.3,6.8)×10⁹/L、98(62,133)×10⁹/L、(29.5±3.4)g/L、225.4(139.5,292.8)μmol/L、55(47,66)μmol/L、136(133,138)mmol/L、1.9(1.6,2.2)及(19.0±2.5)分,BI组分别为7.3(4.8,10.5)×10⁹/L、76(46,110)×10⁹/L、(27.7±3.0)g/L、214.0(120.6,314.7)μmol/L、66(50,103)μmol/L、132(128,136)mmol/L、2.1(1.7,2.7)及(23.2±3.1)分,差异均有统计学意义(P<0.05)。logistic回归结果提示,肝性脑病、MELD评分是HBV-ACLF患者并发BI的独立危险因素(P<0.05),预防性使用抗生素是保护性因素(P<0.05)。生存组年龄、WBC、Alb、TBil、Cr、血清钠、INR及MELD评分分别为48(40,54)岁、6.2(4.1,9.6)×10⁹/L、(28.7±3.3)g/L、198.4(106.5,284.5)μmol/L、59(47,86)μmol/L、134(130,137) mmol/L、2.0(1.7,2.4)及(20.5±4.8)分,死亡组分别为54(45,62)岁、8.3(5.6,12.0)×10⁹/L、(27.0±2.8)g/L、228.2(126.7,364.0)umol/L、78(55,116)umol/L、132(127,134)mmol/L、2.3(1.8,2.9)及(25.2±5.9)分,差异有统计学意义(P<0.05)。两组患者肝性脑病、静脉曲张出血、机械通气、休克、肝肾综合征及肾脏替代疗法等差异有统计学意义(P<0.05)。结论肝性脑病、MELD评分是HBV-ACLF患者并发BI的独立危险因素,预防性使用抗生素可有效改善HBV-ACLF患者预后。

关键词: 乙型肝炎病毒相关慢加急性肝衰竭, 细菌感染, 预防性抗生素

Abstract: Objective To investigate the influencing factors and prognosis of bacterial infection (BI) in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF).Methods A total of 128 patients (94 males and 34 females) with HBV-ACLF admitted to our hospital from January 2016 to April 2021 were enrolled. The average age was 52 (40,62) years. BI was defined as patients with one of the followings: spontaneous bacterial peritonitis, pulmonary infection, biliary tract infection or urinary tract infection. The clinical data was analyzed and compared by t test, chi-square test or rank sum test; Multivariate logistic regression analysis was used to investigate influencing factors of BI in patients with HBV-ACLF.Results Among 128 patients with HBV-ACLF, 24 of which without BI (non-BI group) and 104 of which with BI (BI group). The numbers of patients with prophylactic antibiotics use, hepatic encephalopathy (HE), varicose bleeding and hyponatremia in non-BI group were 7 (29.2%), 3 (12.5%), 2 (8.3%) and 4 (16.7%) respectively, which were significantly higher than those in BI group [13 cases (15.5%), 42 cases(40.4%), 28 cases(26.9%) and 57 cases (54.8%), P<0.05]. The scores of white blood cell (WBC), platelet (PLT), albumin (Alb), total bilirubin (TBil), creatinine (Cr), serum sodium, international normalized ratio (INR) and model for end-stage liver disease (MELD) in non-BI group were 5.3 (4.3, 6.8)×10⁹/L, 98 (62, 133)×10⁹/L, (29.5±3.4) g/L, 225.4 (139.5, 92.8) μmol/L, 55 (47, 66) μmol/L, 136 (133,138) mmol/L, 1.9 (1.6, 2.2) and (19.0 2.5), which were significantly higher than those in BI group [7.3 (4.8, 10.5)×10⁹/L, 76 (46, 110)×10⁹/L, (27.7±3.0)g/L, 214.0 (120.6, 314.7) μmol/L, 66 (50, 103) μmol/L, 132 (128, 136) mmol/L, 2.1 (1.7, 2.7) and (23.2±3.1) points, P<0.05]. All the indexes with significant differences were taken as independent variables for BI in patients with HBV-ACLF (assignment 0=not complicated, 1=complicated). Logistic regression analysis showed that HE and MELD score were independent risk factors (P<0.05), and preventive antibiotic use was protective factor (P<0.05). Patients with HBV-ACLF and BI were divided into survival group and dead group according to the survival outcome. The clinical data of age, WBC, Alb, TBil, Cr, serum sodium, INR and MELD in survival group were 48 (40,54) years old, 6.2 (4.1, 9.6) ×10⁹/L, (28.7±3.3)g/L, 59 (47, 86) μmol/L, 134 (130,137) mmol/l, 2.0 (1.7, 2.4) and (20.5±4.8) points, which were significantly higher than those in the dead group [54 (45,62) years old, 8.3 (5.6, 12.0) ×10⁹/L, 228.2 (126.7, 364.0) μmol/L, 78 (55, 116 ) μmol/L, 132 (127, 134) mmol/l, 2.3 (1.8, 2.9) and (25.2±5.9) points, (P<0.05). There were significant differences in HE, variceal bleeding, mechanical ventilation, shock, hepatorenal syndrome and renal replacement therapy between the 2 groups (P<0.05).Conclusion HE and MELD score are independent risk factors of BI in patients with HBV-ACLF. Preventive antibiotics can effectively improve the prognosis, which has important clinical value.

Key words: Hepatitis B virus-associated acute-on-chronic liver failure, Bacterial infection, Prophylactic antibiotics

仲小强, 储旭东, 陈海燕, 高太俊. HBV相关慢加急性肝衰竭患者并发细菌感染影响因素及预后结局分析[J]. 肝脏, 2022, 27(7): 748-751.

ZHONG Xiao-qiang, CHU Xu-dong, CHEN Hai-yan, GAO Tai-jun. Influencing factors and prognosis of bacterial infection in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2022, 27(7): 748-751.

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