失代偿期慢性乙型肝炎患者自发性细菌性腹膜炎的感染风险预测模型建立  

Construction and application of risk prediction model for spontaneous bacterial peritonitis in patients with decompensated chronic hepatitis B

作　　者：杨洋[1] 陈洋[1] 赵晓明 张娇[1] 孔妍霓 YANG Yang;CHEN Yang;ZHAO Xiao-ming;ZHANG Jiao;KONG Yan-ni(The First Hospital of China Medical University,Shenyang,Liaoning 110001,China)

机构地区：[1]中国医科大学附属第一医院感染科,辽宁沈阳110001

出　　处：《中华医院感染学杂志》2022年第19期2915-2919,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省科研基金资助项目(2020HG3011)。

摘　　要：目的分析失代偿期慢性乙型肝炎患者自发性细菌性腹膜炎(SBP)感染的影响因素,并建立风险预测模型。方法回顾性分析2019年9月-2021年10月于中国医科大学附属第一医院进行治疗的94例失代偿期慢性乙型肝炎SBP患者(感染组)的临床资料,分析其病原菌及耐药率,另选取同期于医院进行治疗的68例失代偿期慢性乙型肝炎未出现SBP患者作为对照组,对比两组一般临床资料,分析影响失代偿期慢性乙型肝炎患者SBP的影响因素,并构建风险预测模型。结果94例患者共检出病原菌102株,其中革兰阳性菌64株占62.75%,以金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌为主,三者均对青霉素完全耐药,对克林霉素、头孢唑林耐药率较高,对利奈唑胺、万古霉素敏感;革兰阴性菌36株占35.29%,以大肠埃希菌、肺炎克雷伯菌为主,均对庆大霉素、氨苄西林、头孢他啶耐药率较高,对磺胺甲噁唑/甲氧苄啶敏感,真菌2株占1.96%;Logistic回归分析发现总胆红素、腹水蛋白、侵入性操作、预防性应用抗菌药物、Child-Pugh评分是失代偿期慢性乙型肝炎患者SBP的影响因素(P<0.05);将总胆红素、腹水蛋白、侵入性操作、预防性应用抗菌药物、Child-Pugh评分代入Logistic预测模型中发现,以上因素在失代偿期慢性乙型肝炎患者SBP感染中的预测敏感度78.65%、特异度为52.33%,曲线下面积(AUC)为0.668。结论革兰阳性菌为失代偿期慢性乙型肝炎患者SBP感染的主要病原菌,利奈唑胺、万古霉素等抗菌药物可作为临床治疗首选药物,另外总胆红素、腹水蛋白、侵入性操作、预防性应用抗菌药物、Child-Pugh评分在失代偿期慢性乙型肝炎患者SBP感染中预测价值较佳,可为临床早期诊断及感染控制提供依据。OBJECTIVE To analyze the independent risk factors of spontaneous bacterial peritonitis(SBP)in patients with decompensated chronic hepatitis B,and construct a risk prediction model.METHODS The clinical data of 94 cases of decompensated chronic hepatitis B patients with SBP(infection group)treated in the First Affiliated Hospital of China Medical University from Sep.2019 to Oct.2021 were retrospectively analyzed.Meanwhile,68 patients with decompensated chronic hepatitis B but without SBP were selected as the control group.General clinical data of the two groups were compared to analyze the independent risk factors for SBP in patients with decompensated chronic hepatitis B.A risk prediction model was constructed.RESULTS A total of 102 pathogenic bacteria strains were detected in the 94 patients,including 64 strains of Gram-positive bacteria,accounting for 62.75%.Among them,the main pathogenic bacteria were Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus faecalis all of which were completely resistant to penicillin,highly resistant to clindamycin and cefazolin,and sensitive to linezolid and vancomycin.There were 36 strains of Gram-negative bacteria,accounting for 35.29%.Among them,the main pathogenic bacteria were Escherichia coli and Klebsiella pneumoniae both of which were highly resistant to gentamicin,ampicillin and ceftazidime,and sensitive to sulfamethoxazole.There were 2 strains of fungi,accounting for 1.96%.Logistic regression analysis found that the level of total bilirubin,ascites protein level,invasive procedures,prophylactic use of antibiotics,and Child-Pugh score were independent risk factors for SBP in patients with decompensated chronic hepatitis B(P<0.05).A prediction model was constructed based on these factors,and it was found that the sensitivity,specificity and AUC of this model to predict SBP in patients with decompensated chronic hepatitis B were 78.65%,52.33%and 0.668.CONCLUSION Gram-positive bacteria are main pathogenic bacteria of SBP in patients with decompensated chronic h

关 键 词：失代偿期 慢性乙型肝炎 自发性细菌性腹膜炎 病原学 影响因素 感染 风险预测模型 

分 类 号：R565.41[医药卫生—呼吸系统]