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  

Clinical analysis of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure

作　　者：陈明胜[1] 甘巧蓉[1] 江晓燕[1] 杨惠安[1] 胡盈莹[1] 潘晨[1] 

机构地区：[1]福州市传染病医院肝病科,350025

出　　处：《中华传染病杂志》2015年第4期193-197,共5页Chinese Journal of Infectious Diseases

基　　金：“十二五”国家科技重大专项一一重型乙型肝炎（肝功能衰竭）临床治疗新方案的研究（2012ZX10002004）;福州市卫生系统科技计划项目（2013-s-w10）;福州市科技计划项目（2011-S-69-4）

摘　　要：目的 探讨HBV相关慢加急性肝功能衰竭合并肺部感染患者的临床特点.方法 回顾性分析2007年1月至2012年12月福州市传染病医院肝病科住院治疗的666例HBV相关慢加急性肝功能衰竭患者的基础临床资料（性别、年龄、肝硬化基础、糖尿病）,并发症发生情况（自发性腹膜炎、肝肾综合征、肝性脑病、上消化道出血）,以及治疗基线时临床检测指标,分析HBV相关慢加急性肝功能衰竭患者合并肺部感染的独立危险因素,并分析肺部感染的病原菌分布.满足正态分布的两组间均数比较采用t检验,非正态分布数据采用非参数统计,两组间比较采用Mann-WhitneyU检验;计数资料的比较采用x2检验或Fisher确切概率法.结果 666例肝功能衰竭患者中有125例合并肺部感染,肺部感染发生率为18.76％,病原菌以真菌最多见（54.84％）,年龄≥60岁患者肺部感染的发生率为41.18％,年龄＜60岁发生率为16.91％,两者比较差异有统计学意义（χ2=19.136,P＜0.01）.125例合并肺部感染患者中合并肝硬化和糖尿病者均高于未合并肺部感染患者,两组比较差异均有统计学意义（均P＜0.01）.血清白蛋白水平、胆固醇、甲胎蛋白、白细胞计数、Hb、PTA、国际标准化比值、血清钠在两组患者间比较差异均有统计学意义（均P＜0.05）.合并肺部感染患者出现自发性腹膜炎、肝性脑病、肝肾综合征的比例高于未合并肺部感染患者,差异均有统计学意义（均P＜0.01）.自发性腹膜炎、年龄、白蛋白、Hb、血清钠对合并肺部感染的发生存在重要的影响,其中白蛋白、Hb、血清钠为保护因素.结论 肺部感染作为肝功能衰竭常见的严重并发症之一,对肝功能衰竭的预后影响显著,早期预测肺部感染发生至关重要,对于高龄,并发自发性腹膜炎,低白蛋白、低血清钠、低Hb的患者应及时预防并监测肺部感染发生.Objective To investigate the clinical features of pulmonary infection in patients with hepatitis B virus （HBV）-related acute-on-chronic liver failure （ACLF）.Methods A total of 666 hospitalized patients with HBV-ACLF in Department of Liver Disease of Fuzhou Infectious Diseases Hospital were retrospectively analyzed.Data of demographic and clinical parameters （sex,age,presence of liver cirrhosis and diabetes）,complications （spontaneous bacterial peritonitis,hepatorenal syndrome,hepatic encephalopathy,and upper gastrointestinal hemorrhage）,and baseline biochemical parameters were collected from the medical records database.Univariate and multivariate regression analyses were performed to determine the independent risk factors of pulmonary infection in patients with ACLF.Distributions of the pathogenic bacteria were further analyzed.Student t test was used for the means consistent with normal distribution,while non-parametric statistics were used for the data consistent with abnormal distribution.Mann-Whitney U test was used for the data between two groups.Chi square test and Fisher exact probability method were used for comparing the count data.Results A total of 125 out of 666 patients with ACLF developed pulmonary infection.The incidence of pulmonary infection was 18.76 % （125/666）..Most patients were infected with fungi （54.84%）.The incidence rate of pulmonary infection in patients with liver failure over 60 years （41.18%） was significantly higher than that in patients under 60 years （16.91%;χ2 =19.136,P〈0.01）.The incidence of cirrhosis or diabetes in the 125 patients with pulmonary infection was higher than patients with no pulmonary infection.The difference between the two groups was statistically significant （P〈0.01）.Levels of albumin,cholesterol,alphafetoprotein,white blood cell count,hemoglobin,plasma thromboplastin antecedent,international normalized ratio （INR）,and serum sodium were all significantly different between the two groups （all P〈 0.05）.The incid

关 键 词：肝炎病毒 乙型 肝功能衰竭 肺炎 预后 回归分析 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学] R563.1