终末期肝病患者并发肺部感染的危险因素  

Risk factors of pulmonary infection in patients with end-stage liver disease

作　　者：王月平 赵国厚[2] 尹飞飞[3] 孙龙 王应琼[4] 陈兴峰[4] 王珊[5] Wang Yueping;Zhao Guohou;Yin Feifei;Sun Long;Wang Yingqiong;Chen Xingfeng;Wang Shan(Department of Infectious Diseases,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Respiratory Medicine,the Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China;Hainan Medical University-University of Hong Kong Joint Laboratory of Tropical Infectious Diseases,Haikou 570216,China;Department of Respiratory Medicine,the Second Affiliated Hospital of Hainan Medical University,Haikou 57031l,China;Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]海南医学院第一附属医院感染性疾病科,海口570102 [2]昆明医科大学第二附属医院呼吸内科,昆明650000 [3]海南医学院-香港大学热带传染病联合实验室,海口570216 [4]海南医学院第二附属医院呼吸内科,海口570311 [5]昆明医科大学第二附属医院消化内科,昆明650000

出　　处：《国际呼吸杂志》2023年第9期1041-1045,共5页International Journal of Respiration

摘　　要：目的寻找终末期肝病患者并发肺部感染的危险因素。方法本研究为观察性研究。采用非随机抽样的方法选取海南医学院第一附属医院和海南医学院第二附属医院2017年1月至2022年1月收治的167例终末期肝病患者。根据住院期间是否发生肺部感染分为感染组(61例)与未感染组(106例),对比2组患者性别、年龄、身体质量指数、使用抗菌药物是否合理、是否有侵入性操作、是否合并消化道出血、细菌性腹膜炎、基础疾病、总胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原活动度、白蛋白、D-二聚体水平,通过受试者工作特征(ROC)曲线分析实验室指标预测终末期肝病合并肺部感染的价值,通过多因素logistic回归分析明确终末期肝病患者合并肺部感染的危险因素。结果2组患者性别、年龄、体质量指数、总胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原活动度水平比较差异均无统计学意义(均P>0.05)。感染组白蛋白水平低于未感染组,不合理使用抗菌药物、有侵入性操作、合并消化道出血、合并细菌性腹膜炎、合并基础疾病占比和D-二聚体水平均高于未感染组,差异均有统计学意义(均P<0.05)。经ROC分析证实血清白蛋白、D-二聚体水平均可预测终末期肝病合并肺部感染,曲线下面积分别为0.673、0.786,最佳截断值分别为27.80 g/L、698.00μg/L(均P<0.05)。经多因素logistic回归分析证实,白蛋白<27.80 g/L、D-二聚体≥698.00μg/L、使用抗菌药物不合理、合并细菌性腹膜炎、合并基础疾病是肺部感染的危险因素(均P<0.05)。结论白蛋白<27.80 g/L、D-二聚体≥698.00μg/L、使用抗菌药物不合理、合并细菌性腹膜炎、合并基础疾病均是终末期肝病并发肺部感染的危险因素。ObjectiveTo explore the risk factors of pulmonary infection in patients with end-stage liver disease.MethodsThis was an observational study.A non-random sampling method was used to select 167 patients with end-stage liver disease from January 2017 to January 2022 in the Department of Infectious Diseases of the First Affiliated Hospital of Hainan Medical University and the Second Affiliated Hospital of Hainan Medical University.According to whether pulmonary infection occurred during hospitalization,the patients were divided into infected group(61 cases)and uninfected group(106 cases).Sex,age,body mass index,rational use of antibacterial drugs,invasive operation,gastrointestinal bleeding,bacterial peritonitis,basic diseases,total bilirubin,alanine aminotransferase,aspartate aminotransferase,prothrombin activity,albumin,and D-dimer levels of the two groups were compared.The value of laboratory indexes in predicting end-stage liver disease complicated with pulmonary infection was analyzed by receiver operating characteristic(ROC)curve,and the risk factors of pulmonary infection were identified by multivariate logistic regression analysis.ResultsThere was no significant difference in age,sex,body mass index,total bilirubin,alanine aminotransferase,aspartate aminotransferase,and prothrombin activity between the two groups(P>0.05).The albumin level in the infected group was lower than that in the uninfected group,and the proportion of irrational use of antibiotics,invasive operation,gastrointestinal bleeding,bacterial peritonitis,basic diseases,and D-dimer level were all higher than those in the uninfected group,with statistical significance(P<0.05).ROC analysis confirmed that serum albumin and D-dimer levels can be used to predict end-stage liver disease complicated with pulmonary infection with areas under the curve of 0.673 and 0.786 respectively,and the optimal cut-off values of 27.80 g/L and 698.00μg/L respectively(all P<0.05).Multivariate logistic regression analysis showed that albumin<27.80 g/L,D-D≥698.00μg

关 键 词：终末期肝病 危险因素 肺部感染 

分 类 号：R575[医药卫生—消化系统] R563.1[医药卫生—内科学]