78例肝硬化患者肠道细菌易位及其相关性研究

Investigation of intestinal bacterial translocation in 78 patients with cirrhosis after liver transplantation

目的了解肝硬化患者肠道细菌易位(BT)的发生率及其相关危险因素,分析BT与术后感染的关系。方法对77例肝移植和1例未行肝移植的肝硬化患者进行术中采样,取外周血、门脉血及肠系膜淋巴结(MLN),分别进行需氧及厌氧培养,了解BT的发生率。结合术前、术后各种临床资料分析发生BT的危险因素及BT的临床意义。结果78例肝硬化患者中BT的发生率为10·3%(8/78);细菌易位的部位以MLN为主,占5/8,发生BT的细菌主要是肠道G-兼性厌氧杆菌(55·6%),其次为G+兼性厌氧球菌(22·2%)。BT组患者术前胆红素总量显著高于无BT组(P=0·022);发生BT的患者其术后感染的风险是无BT患者的1·3倍。结论高胆红素血症是促发BT的独立危险因素,发生BT的肝移植患者术后感染的风险明显升高。

Objective To investigate the prevalence and associated risk factors of bacterial translocation （BT） in patients with cirrhosis after liver transplantation and analyze the effect of BT on bacterial infection after the surgery. Methods Mesenteric lymph nodes （ MLN）, portal vein blood, and peripheral blood were collected during the liver transplantation for microbiological culture from 78 patients with cirrhosis. And meanwhile, all related clinical data were analyzed to investigate the risk factors of BT and its relationship with post-liver transplantation infections. Results BT was occurred in 8 of 78 cirrhotic patients （ 10. 3% ） and positive-rate of MLN culture was 5/8. Gram-negative aerobic bacillus was the main causative bacterium of BT （5/9）, followed by Gram-positive aerobic enterococcus （22. 2% , 2/9 ）. Total bilirubin level in patients with BT was significantly higher than that in patients without BT. Conclusions It sugests that hyperbilirubinemia is the only risk factor for BT, and BT is associated with an increased infectious rate after liver transplantation.