乙型肝炎肝衰竭住院患者肺部感染的病原菌特点及预后分析

摘要/Abstract

摘要： 目的探讨乙型肝炎肝衰竭住院患者肺部感染的病原菌特点及其预后不良的影响因素。方法选取2019年1月至2021年1月徐州医科大学附属沭阳医院收治乙型肝炎肝衰竭患者103例。所有患者入院后均行内科常规支持治疗及常规抗病毒治疗,依据患者存活情况分为预后良好与预后不良组。对于出现肺部感染者开展病原学培养,分析病原菌分布。比较两组基线资料及实验室指标差异,并通过多因素logistic分析明确患者预后不良的危险因素。结果 103例患者中20例住院期间出现肺部感染,发生率为19.4%。20例肺部感染患者均完成病原学培养,共分离出病原菌57株,其中革兰阳性菌8株,占比14.0%,革兰阴性菌19株,占比33.3%,真菌30株,占比52.6%。预后不良组年龄≥60岁占比显著高于预后良好组(72.9%比40.9%, P<0.05),预后不良组MELD评分＞18分占比显著高于预后良好组(57.6%比34.1%, P<0.05),预后不良组肺部感染占比显著高于预后良好组(30.5%比4.6%, P<0.05),预后不良组电解质紊乱占比显著高于预后良好组(25.4%比6.8%, P<0.05)。经多因素logistic分析结果显示,年龄≥60岁、MELD评分＞18分、肺部感染、电解质紊乱是患者预后不良的危险因素(P<0.05)。结论肺部感染是乙型肝炎肝衰竭患者预后不良的危险因素之一,对于肺部感染患者应当及时行病原菌分析,及时使用有效的广谱抗生素进行治疗,以改善其预后。

关键词: 乙型肝炎, 肝衰竭, 肺部感染, 病原菌, 预后

Abstract: Objective To investigate the pathogenic characteristics of pulmonary infection in hospitalized patients with hepatitis B liver failure, as well as the factors associate with poor prognosis. Methods A total of 103 patients with hepatitis B liver failure, who were hospitalized in Shuyang Hospital Affiliated to Xuzhou Medical University from January 2019 to January 2021, were selected as the study subject. All patients received routine medical support treatment and routine antiviral therapy for hepatitis B virus (HBV) after admission. After hospitalization, all patients were followed up for 1 year with regular check-ups every 3 months. The patients were divided into two groups based on their prognosis: the good prognosis group and the poor prognosis group. During hospitalization, the patient were closely monitored for the occurrence of pulmonary infection. Pathogenic culture was conducted for those who developed pulmonary infection to identify the distribution of pathogenic bacteria. Additionally, baseline data information including age, gender, body mass index, liver failure classification, presence of family history of hepatitis B, MELD score, presence of lung infection, electrolyte disorders were compared between the two groups. Laboratory indicators such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), platelet count (PLT), urea nitrogen (BUN), creatinine (SCR), hepatitis B virus DNA (HBV DNA) and HBeAg were also compared. Furthermore, multifactor logistic analysis was conducted to identify the risk factors associated with poor prognosis in patients. Results Among the 103 patients included in the study, 20 (19.4%) patients developed pulmonary infection during hospitalization. All 20 patients with pulmonary infection underwent pathogenic culture, and 57 strains of pathogenic bacteria were isolated. These included 8 strains of Gram positive bacteria (14.0%), 19 strains of Gram negative bacteria (33.3%), and 30 strains of fungi (52.6%). The proportion of patients aged ≥ 60 years in the poor prognosis group was significantly higher than that in good prognosis group (72.9% vs 40.9%, P<0.05). The proportion of patients with MELD score>18 in the poor prognosis group was significantly higher than that in the good prognosis group (57.6% vs 34.1%, P<0.05). The proportion of pulmonary infection in poor prognosis group was significantly higher than that in good prognosis group (30.5% vs 4.6%, P<0.05). The proportion of electrolyte disturbance in poor prognosis group was significantly higher than that in good prognosis group (25.4% vs 6.8%, P<0.05). Multivariate logistic analysis showed that age ≥ 60 years, MELD score>18, pulmonary infection, and electrolyte disorder were identified as the risk factors for poor prognosis (P<0.05). Conclusion Pulmonary infection is one of the risk factors for poor prognosis in patients with hepatitis B liver failure. Patients with pulmonary infection during hospitalization should be analyzed and treated with effective broad-spectrum antibiotics in a timely manner to improve their prognosis.

Key words: Hepatitis B liver, Liver failure, Pulmonary infection, Pathogenic bacteria, Prognosis

徐小国, 司进枚, 陈民, 应学敏. 乙型肝炎肝衰竭住院患者肺部感染的病原菌特点及预后分析[J]. 肝脏, 2023, 28(10): 1204-1207.

XU Xiao-guo, SI Jin-mei, CHEN Min, YING Xue-min. Pathogen characteristics and prognosis of pulmonary infection in hospitalized patients with hepatitis B liver failure[J]. Chinese Hepatolgy, 2023, 28(10): 1204-1207.

参考文献

[1] Hughes RD, Pucknell A, Langley PG, et al. Evaluation of the biologic-dt sorbent-suspension dialyser in patients with fulminant hepatic failure. Int J Artif Organs,2018,17(12):657-662.
[2] Go YM, Li FY, Gong M, et al. Short-term efficacy of treating hepatitis b virus-related acute-on-chronic liver failure based on cold pattern differentiation with hot herbs: a randomized controlled trial. Chin J Integr Med,2016(8):573-580.
[3] Wang N, Fan YC, Xia HH, et al. Plasma interleukin-10 predicts short-term mortality of acute-on-chronic hepatitis b liver failure. Aliment Pharmacol Ther,2016,43(11):1208-1221.
[4] Chen J, Yang Q, Huang JR, et al. Risk factors for invasive pulmonary aspergillosis and hospital mortality in acute-on-chronic liver failure patients: a retrospective-cohort study.Int J Med Sci,2013,10(12):1625-1631.
[5] Peng Y, Qi XS, Tang SH, et al. Child-pugh, meld and albi scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol,2016,10(8):971-980.
[6] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010年版). 中华临床感染病杂志,2011,50(2):168-179.
[7] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版). 中华临床感染病杂志,2018, 11(6):401-410.
[8] 陈明胜, 甘巧蓉, 江晓燕, 等. 乙型肝炎病毒相关慢加急性肝功能衰竭患者合并肺部感染的临床分析. 中华传染病杂志,2015, 33(4):193-197.
[9] 段红岩, 秦红, 李尧. 乙型肝炎肝衰竭并发感染患者病原菌分布及血清HMGB1和sICAM-1水平变化. 实用肝脏病杂志,2020, 23(4):548-551.
[10] 石磊, 徐斌, 于法涛, 等. 乙肝相关慢加急性肝功能衰竭患者并发肺部感染的临床研究. 中华医院感染学杂志,2016, 26(21):4900-4902.
[11] Buechter M, Manka P, Heinemann FM, et al. Potential triggering factors of acute liver failure as a first manifestation of autoimmune hepatitis-a single center experience of 52 adult patients. World J gastroenterol,2018,24(13):1410-1418.
[12] Blasco-Algora S, Masegosa-Ataz J, Gutiérrez-García ML, et al. Acute-on-chronic liver failure: pathogenesis, prognostic factors and management. World J Gastroenterol,2015,21(42):12125-12140.
[13] Li TP, Guan SH, Wang Q, et al. Soluble mannose receptor as a predictor of prognosis of hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol,2019,25(37):5667-5675.
[14] Chen W, You J, Chen J, et al. Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol,2017(40):7303-7309.
[15] Fernandez J, Acevedo JG, Wiest R, et al. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis. J Hepatol,2017,66(1):379-379.
[16] Shi Y, Zheng MH, Ying Y, et al. Prior decompensation is associated with delayed mortality in patients with acute-on-chronic liver failure. J Gastroenterol Hepatol,2014,30(4):712-718.