失代偿期肝硬化患者大肠埃希菌血流感染临床及预后分析  

Clinical and prognostic analysis of decompensated cirrhosis patients Escherichia coil bloodstream infections

作　　者：何卫平[1] 杨柳[3] 鲍春梅[2] 张文瑾[1] 崔恩博[2] 蔡少平[1] 范振平[1] 曲芬[2] 

机构地区：[1]解放军第三〇二医院军人肝病诊疗中心,北京100039 [2]解放军第三〇二医院军人临床检验医学中心,北京100039 [3]北京协和医学院医学信息研究所

出　　处：《中华医学杂志》2015年第13期1006-1011,共6页National Medical Journal of China

基　　金：全军医学科技“十二五”科研项目重点课题（BWS11C-073）

摘　　要：目的分析失代偿期肝硬化患者大肠埃希菌血流感染的临床特点及耐药性，探讨影响疾病预后的危险因素。方法回顾性分析2009-2012年在解放军第三。二医院住院的失代偿期肝硬化患者血流感染大肠埃希菌患者的临床资料，以是否存活作为预后判定的终点指标，分别进行单因素及多因素Logistic回归分析，探讨影响患者预后的危险因素。结果2009-2012年失代偿期肝硬化患者血流感染大肠埃希菌共211例，超广谱B内酰胺酶（ESBLs）阳性80株，阳性率37．9％。多数血流感染来源不明或不确定，ESBLs阳性大肠埃希菌耐药性高于ESBLs阴性大肠埃希菌，但两者在年龄、性别、基础疾病、原发病灶、体温峰值、白细胞计数及中性粒细胞百分率等方面比较差异均无统计学意义。本组患者治疗后治愈好转154例，无效及死亡共57例，无效病死率达27．0％，通过对生存组和死亡组的单因素及多因素Logistic回归分析提示，年龄大、脉搏不正常、肝衰竭、肝性脑病、感染性休克、急性肾损伤、消化道出血是预后差的危险因素，体温超过39℃（OR=0．301）对降低病死率具有保护作用。通过建立的Logistic预测概率模型，得到ROC曲线，曲线下面积为0．898。结论失代偿期肝硬化患者血流感染大肠埃希菌病情危重，预后不良，早期进行有效的抗感染治疗和积极预防严重并发症的发生可以降低病死率。Objective To investigate the clinical characteristic and drug resistance of decompensated cirrhosis patients bloodstream infections causing by Escherichia coli, and determine risk factors for mortality among patients with bloodstream infections. Methods The clinical data and drug susceptibility of decompensated cirrhosis patients Escherichia coli bloodstream infections from 2009 to 2012 in 302 hospital of PLA were retrospectively analyzed. Univariable and multivariable Logistic regression was used to identify independent risk factors for all-cause mortality. Results A total 211 strains of E. coli were isolated from decompensated cirrhosis inpatients, 80 strains ESBLs detecting were positive, positive rate was 37.9%. Most of infection source were uncertain. The drug resistance of ESBLs positive strains was higher than ESBLs negative strains, but no statistical difference existed in age, sex, basic disease, infection source, peak temperature, white blood cell count, the percentage of neutrophils between ESBLs positive strains and negative strains. 154 patients were survived and 57 patients were died after treatment, with a mortality of 27.01%. On multivariate analysis, independent risk factors for in-hospital mortality were old age [odds ratio （OR） = 2.429], abnormal pulse （ OR = 2.977）, liver failure （ OR = 11. 159）, hepatic encephalopathy（ OR = 2. 524 ）, septic shock （ OR = 8. 837 ）, acute kidney injury （ OR = 3. 758 ）, gastrointestinal bleeding（ OR =4. 118）. Body temperature of 〉 39 ℃ （OR =0. 301 ） had protective effect to lower mortality. A Logistic probobility model was created by adding points for each independent risk factor, and had a c-statistic of 0. 898. Conclusions Due to decompensated cirrhosis patients Escherichia coli bloodstream infection severity and bad prognosis, early effective antimicrobial therapy and severe complication prevention should be taken to reduce mortality.

关 键 词：肝硬化 肠出血性大肠杆菌 失代偿期 预后 

分 类 号：R575.2[医药卫生—消化系统]