影响慢加急性乙型肝炎肝衰竭并发医院获得性肺炎患者预后危险因素分析  

Factors impacting prognosis of patients with acute-on-chronic hepatitis B liver failure complicated by hospital-acquired pneumonia

作　　者：丘仲琼 林建辉[2] 翁钘钘 陈丽霞[2] 刘海钰 Qiu Zhongqiong;Lin Jianhui;Weng Yanyan(ClinicalLaboratory,Mengchao Hepatobiliary Hospital,Affiliated to Fujian Medical University,Fuzhou 350001,Fujian Province,China)

机构地区：[1]福建医科大学孟超肝胆医院医学检验中心,福州市350001 [2]福建医科大学肝病科/人工肝中心,福州市350001 [3]福建医科大学附属协和医院呼吸与危重症医学科,福州市350001

出　　处：《实用肝脏病杂志》2024年第6期878-881,共4页Journal of Practical Hepatology

基　　金：福建省自然科学基金资助项目(编号:2021J011293)。

摘　　要：目的分析慢加急性乙型肝炎肝衰竭(HBV-ACLF)并发医院获得性肺炎(HAP)患者预后的影响因素。方法2018年1月~2022年12月我院诊治的HBV-ACLF并发HAP患者101例,给予内科综合和人工肝治疗。使用法国生物梅里埃VITEK MS公司生产的微生物质谱检测系统进行细菌鉴定。应用单因素和多因素Logistic回归分析影响预后的因素。结果本组HBV-ACLF并发HAP患者痰培养76例(75.3%)致病菌阳性,其中革兰氏阴性菌30株(39.5%),革兰氏阳性菌11株(14.5%)和真菌35株(46.1%);在住院(44.7±24.4)d内,死亡50例(49.5%),生存51例(50.5%);死亡组年龄、血浆乳酸、MELD评分、并发并自发性细菌性腹膜炎(SBP)和并发消化道出血占比分别为(57.3±12.1)岁、(2.7±2.1)mmol/L、(27.5±6.9)分、66.0%和42.0%,均显著高于生存组【分别为(50±12.8)岁、(1.6±0.8)mmol/L、(22.5±7.3)分、31.4%和5.9%,P<0.05】;多因素Logistic回归分析发现年龄(OR=1.054,95%CI:1.005~1.110)、血浆乳酸(OR=2.339,95%CI:1.255~5.031)、并发SBP(OR=6.784,95%CI:2.139~25.206)和并发消化道出血(OR=18.504,95%CI:3.973~122.636)是影响预后的独立危险因素(P<0.05)。结论HBV-ACLF并发HAP患者预后差,临床上应重视年龄较大和存在其他并发症的处理,以期及早干预,改善预后。Objective The aim of this study was to analyze influencing factors of patients with acute-on-chronic hepatitis B liver failure(HBV-ACLF)complicated by hospital-acquired pneumonia(HAP).Methods A total of 101 patients with HBV-ACLF and HAP were encountered in our hospital between January 2018 and December 2022,and all received comprehensive internal medical and liver-supporting treatment.Sputum culture and bacteria characterization were routinely performed.Univariate and multivariate Logistic regression analysis was applied to analyze independent risk factors influencing prognosis.Results Of 101 patients with HBV-ACLF and HAP,sputum obtained positive results in 76 cases(75.3%),and out of them,Gram positive pathogenic bacteria strain was found in 30 cases(39.5%),Gram negative in 11 cases(14.5%)and fungus in 35 cases(46.1%);50 patients(49.5%)died and 51 patients(50.5%)survived during(44.7±24.4)day hospital stay;ages,plasma lactate level,model of end-stage liver disease score,percentages of concomitant spontaneous bacterial peritonitis(SBP)and gastrointestinal bleeding(GIB)in dead patients were(57.3±12.1)yr,(2.7±2.1)mmol/L,(27.5±6.9)point,66.0%and 42.0%,all much higher than[(50±12.8)yr,(1.6±0.8)mmol/L,(22.5±7.3)point,31.4%and 5.9%,respectively,P<0.05]in survivals;multivariate Logistic regression analysis showed that age(OR=1.054,95%CI:1.005-1.110),plasma lactate level(OR=2.339,95%CI:1.255-5.031),concomitant SBP(OR=6.784,95%CI:2.139-25.206)and GIB(OR=18.504,95%CI:3.973-122.636)were the independent risk factors impacting prognosis(P<0.05).Conclusion The patients with HBV-ACLF and HAP have a poor prognosis,clinicians should pay more attention to those who are elderly and with more than one complications,and take an appropriate measures in time to improve the outcomes.

关 键 词：慢加急性肝衰竭 医院获得性肺炎 致病菌 预后 影响因素 

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