乙型肝炎病毒相关肝衰竭并发自发性细菌性腹膜炎的危险因素

Risk factors of hepatitis B virus related liver failure complicated with spontaneous bacterial peritonitis

目的探讨乙型肝炎病毒(HBV)相关肝衰竭并发自发性细菌性腹膜炎(SBP)的危险因素。方法采用回顾性队列研究方法,选择住院的HBV相关肝衰竭患者作为研究对象,应用Logistic回归分析对年龄、性别、生化指标、凝血指标、HBVDNA载量、临床分型等进行单因素和多因素分析。结果共676例肝衰竭患者入选本研究,其中并发SBP者占71.0%(480/676),仅高胆红素血症、低ALT/AST、低钠血症与肝衰竭并发SBP相关(P=0.014、P<0.001、P=0.041),TBil>380μmol/L、ALT/AST≤0.4、血钠≤125mmol/L发生SBP的风险分别高于TBil≤380μmol/L、ALT/AST>0.4、血钠>125mmol/L[P=0.026,OR(95%CI)=1.469(1.047～2.060);P=0.033,OR(95%CI)=2.388(1.049～5.434);P=0.001,OR(95%CI)=4.244(1.664～10.829)]。结论高胆红素血症、低ALT/AST、低钠血症是肝衰竭并发SBP的独立危险因素。

Objective To investigate the risk factors of spontaneous bacterial peritonitis（SBP）in patients with hepatitis B virus related liver failure.Methods Patients with hepatitis B virus related liver failure were recruited for clinical data including age,sex,biochemical indicator,blood clotting indicator,HBV DNA loads,clinical typing,et al,which were analyzed as risk factors with univariate and multivariate Logistic regression.Results Total of 676 patients with hepatitis B virus related liver failure were recruited,among whom the prevalence rate of SBP was 71.0%（480/676）.Logistic regression analysis showed that hyperbilirubinemia,low levels of serum alanine aminotransferase（ALT）to serum aspartate aminotransferase（AST）ratio and hyponatremia were correlated with the presence of SBP（P = 0.014,P 0.001,P = 0.041,respectively）.Furthermore,total bilirubin level 380 μmol/L,ALT/AST level ≤ 0.4 and serum sodium concentration ≤125 mmol/L indicated higher risk on the presence of SBP than total bilirubin level ≤ 380 μmol/L,ALT/AST level 0.4 and serum sodium concentration 125 mmol/L [P = 0.026,OR（95%CI）=1.469（1.047～2.060）;P = 0.033,OR（95%CI）= 2.388（1.049～5.434）;P=0.001,OR（95%CI）= 4.244（1.664～10.829）,respectively].Conclusions Hyperbilirubinemia,low levels of ALT/AST and hyponatremia are independent risk factors for the presence of SBP in patients with HBV related liver failure.