第三代头孢菌素治疗社区获得性自发性细菌性腹膜炎效果预测模型的临床价值  

Clinical application value of a predictive model for the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis

作　　者：朱龙川[1] 吴蔚[2] 甘达凯 张伟[1] 徐意珍 熊墨龙[1] ZHU Longchuan;WU Wei;GAN Dakai;ZHANG Wei;XU Yizhen;XIONG Molong(Department of Hepatology,The Ninth Hospital of Nanchang,Nanchang 330002,China;Department of Gastroenterology,Jiangxi Provincial Children’s Hospital,Nanchang 330006,China)

机构地区：[1]南昌市第九医院肝病科,南昌330002 [2]江西省儿童医院消化科,南昌330006

出　　处：《临床肝胆病杂志》2024年第2期306-311,共6页Journal of Clinical Hepatology

基　　金：江西省重点研发计划项目(20181BBG78010)。

摘　　要：目的探讨第三代头孢菌素(3^(rd)GC)治疗社区获得性自发性细菌性腹膜炎(CASBP)效果预测模型的临床应用价值。方法前瞻性选取2021年1月—2022年6月南昌市第九医院新入院的肝硬化伴CASBP患者50例,随机分为优化治疗组(n=25)与传统治疗组(n=25),前者基于效果预测模型采用头孢他啶或亚胺培南初治,后者均采用头孢他啶初治,此后依据初治效果调整抗生素,比较两组的初治有效率、第5天治愈率及30天病死率。计量资料两组间比较采用成组t检验或MannWhitney U检验。计数资料两组间比较采用χ^(2)检验或Fisher精确概率法。结果所有患者均完成研究。优化治疗组初治有效率明显高于传统治疗组(88.0%vs 60.0%,χ^(2)=5.094,P=0.024),两组第5天治愈率相当(80.0%vs 56.6%,χ^(2)=3.309,P=0.069)。均使用头孢他定初治的患者中,优化治疗组初治有效率亦明显高于传统治疗组(88.9%vs 60.0%,χ^(2)=4.341,P=0.037),两组第5天治愈率相当(83.3%vs 56.0%,χ^(2)=2.425,P=0.119)。两组患者的30天病死率分别为8.0%和20.0%,差异无统计学意义(χ^(2)=0.664,P=0.415)。所有入组患者初治有效与第5天治愈关联明显(OR=9.643,95%CI:2.292~40.564),第5天治愈与患者30天死亡关联明显(OR=0.138,95%CI:0.023~0.813)。结论该疗效预测模型有助于临床医生筛选3rdGC治疗的优势患者,提高3rdGC经验性治疗CASBP的初治疗效。Objective To investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis(CASBP).Methods This prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022,and the patients were randomly divided into optimized treatment group and traditional treatment group,with 25 patients in each group.The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model,and those in the traditional treatment group received ceftazidime for initial treatment,with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment.The two groups were compared in terms of the response rate of initial treatment,cure rate on day 5,and 30-day mortality rate.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Results All patients completed the study.The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group(88.0%vs 60.0%,χ^(2)=5.094,P=0.024),while there was no significant difference in the cure rate on day 5 between the two groups(80.0%vs 56.6%,χ^(2)=3.309,P=0.069).As for the patients who received ceftazidime for initial treatment,the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group(88.9%vs 60.0%,χ^(2)=4.341,P=0.037),while there was no significant difference in the cure rate on day 5 between the two groups(83.3%vs 56.0%,χ^(2)=2.425,P=0.119).There was no significant difference in 30-day mortality rate between the two groups(8.0%vs 20.0%,χ^(2)=0.664,P=0.415).For all patients,there was a significant

关 键 词：肝硬化 腹膜炎 社区获得性感染 头孢菌素类 治疗结果 

分 类 号：R572.2[医药卫生—消化系统]