摘要
目的 分析肝硬化合并感染患者的临床特点,明确其相关危险因素,为临床治疗提供参考依据.方法 回顾性总结2014年4月—2017年6月首都医科大学附属北京友谊医院住院的肝硬化合并感染患者的临床资料,分析院内及社区感染患者的临床特点和导致患者死亡的相关因素.结果 1670例住院肝硬化患者中合并感染294例,感染总体发生率为17.6％.剔除资料不完整的病例后共纳入208例肝硬化合并感染者,其中以酒精性肝硬化最常见62例（29.8％）,其次为病毒性肝炎54例（26.0％）和自身免疫性肝病46例（22.1％）.最常见的感染部位为呼吸道146例（70.2％）,其次为泌尿系、胃肠道及腹腔.从32例患者中分离出46株病原体,其中革兰阴性菌22株（47.8％）、革兰阳性菌16株（34.8％）、结核分枝杆菌2株（4.3％）;真菌5株（10.9％）;支原体1株（2.2％）.院内感染患者病死率16.7％（7/42）高于社区感染病死率6.0％（10/166,P=0.025）.17例死亡病例均为失代偿期肝硬化患者,多因素分析提示肝性脑病及凝血酶原时间为预测死亡的独立危险因素.结论 肝硬化失代偿患者更易发生感染,肝性脑病和凝血酶原时间是失代偿肝硬化患者感染后预测死亡的独立危险因素.
Objective To analyze the clinical features and risk factors of cirrhotic patients complicated with infections. Methods The clinical and laboratory characteristics of cirrhotic patients complicated with infections hospitalized from April 2014 to June 2017 were retrospectively analyzed. Relevant risk factors for infection and mortality were explored. Results The overall incidence of infections was 17.6％ in 1670 hospitalized cirrhotic patients. Among the recruited 208 patients in this study, alcoholic, viral hepatitis B or C and autoimmune liver diseases accounted for 29.8％ （62/208）, 26.0％ （54/208）, and 22.1％ （46/208）, respectively. The most common infection site was respiratory tract （70.2％ ）, followed by urinary tract, intestinal and intra-abdomen. Forty-six pathogens were isolated from 32 patients, including 22 （47.8％ ） Gram negative bacteria, 16 （34.8％ ） Gram positive bacteria and 2（4.3％ ） mycobacterium tuberculosis, 5 （10.9％） fungi and 1 （2.2％） mycoplasma. The mortality in patients with nosocomial infections （16.7％,7/42） was higher than that in patients with community-acquired infections （6.0％,10/166, P=0.025）. All 17 deaths occurred in decompensated cirrhosis. Multivariate analysis demonstrated that hepatic encephalopathy and prothrombin time were independent risk factors of mortality. Conclusions Patients with decompensated cirrhosis are more susceptible to infections. Hepatic encephalopathy and prothrombin time are independent risk factors for death.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2018年第2期118-122,共5页
Chinese Journal of Internal Medicine
基金
首都临床特色应用研究与成果推广（Z171100001017037）
北京市卫生系统高层次卫生技术人才学科骨干资助项目（2015-3-003）
关键词
肝硬化
感染
Liver cirrhosis
Infection
