肝硬化食管胃底静脉曲张内镜治疗术后感染危险因素及实验室指标早期预测价值  

Risk factors for postoperative infection in patients with esophageal and gastric varices in liver cirrhosis undergoing endoscopic treatment and early prediction value of laboratory test indexes

作　　者：胡倩[1] 杜国强[1] 王建英[1] 寇应琳[1] 田杰[1] 崔小兵[2] HU Qian;DU Guo-qiang;WANG Jian-ying;KOU Ying-lin;TIAN Jie;CUI Xiao-bing(Zhengzhou Railway Vocational and Technical College,Zhengzhou,Henan 450000,China;不详)

机构地区：[1]郑州铁路职业技术学院,河南郑州450000 [2]郑州大学第五附属医院胃肠甲状腺外科,河南郑州450000

出　　处：《中华医院感染学杂志》2022年第10期1514-1518,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划基金资助项目(2018092219)。

摘　　要：目的 探讨肝硬化食管胃底静脉曲张内镜治疗术后感染危险因素及实验室指标早期预测价值。方法 选择2019年1月-2020年12月郑州大学第五附属医院收治的144例因肝硬化食管胃底静脉曲张行内镜治疗的患者作为研究对象,根据患者术后是否发生感染分为感染组与非感染组。采用多因素logistic回归分析患者术后感染的影响因素,采用受试者工作特征曲线(ROC)分析实验室指标对术后感染的预测价值。结果 144例因肝硬化食管胃底静脉曲张行内镜治疗的患者术后有26例发生感染,感染率为18.06%,多因素logistic回归分析显示,合并糖尿病,消化道出血是肝硬化食管胃底静脉曲张内镜治疗术后感染的危险因素(P<0.05),感染组总胆红素(TBIL)、凝血酶原时间(PT)高于非感染组(P<0.05),白蛋白(Alb)低于非感染组(P<0.05),TBIL、PT及Alb联合预测术后感染的AUC为0.881。26例感染患者共检出34株病原菌,革兰阴性菌22株,占64.71%,革兰阳性菌11株,占32.35%,真菌1株,占2.94%。结论 肝硬化食管胃底静脉曲张内镜治疗术后感染以革兰阴性菌为主,糖尿病、消化道出血可增加术后感染发生风险,TBIL、PT及Alb构建的风险预测模型对术后感染发生有较高的预测价值。OBJECTIVE To explore the risk factors for postoperative infection in patients with esophageal and gastric varices in liver cirrhosis undergoing endoscopic treatment and early prediction value of laboratory test indexes. METHODS A total of 144 patients who received endoscopic treatment due to esophageal and gastric varices in liver cirrhosis in the Fifth Affiliated Hospital of Zhengzhou University from Jan 2019 to Dec 2020 were recruited as the study objects and divided into the infection group and the non-infection group according to the status of postoperative infection. Multivariate logistic regression analysis was performed for influencing factors for the postoperative infection, and the values of laboratory test indexes in prediction of the postoperative infection were analyzed by receiver operating characteristic(ROC) curve. RESULTS Of the 144 patients who received endoscopic treatment due to esophageal and gastric varices in liver cirrhosis, 26 had postoperative infection, with the infection rate 18.06%. Multivariate logistic regression analysis showed that complication with diabetes mellitus and gastrointestinal hemorrhage were the risk factors for the postoperative infection in the patients with esophageal and gastric varices in liver cirrhosis(P<0.05). The total bilirubin(TBIL) and prothrombin time(PT) of the infection group were higher than those of the non-infection group(P<0.05), the albumin(Alb) level of the infection group was lower than that of the non-infection group(P<0.05). The AUC of the combined detection of TBIL, PT and Alb was 0.881 in prediction of postoperative infection. Totally 34 strains of pathogens were isolated from 26 patients with infection, 22(64.71%) of which were gram-negative bacteria, 11(32.35%) were gram-positive bacteria, and 1(2.94%) was fungus. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the esophageal and gastric varices in liver cirrhosis patients who have infection after endoscopic treatment. Diabetes mellitus and gastrointestina

关 键 词：肝硬化 食管胃底静脉曲张 内镜 感染 病原菌 预测价值 

分 类 号：R619.3[医药卫生—外科学]