肝硬化合并自发性细菌性腹膜炎相关因素分析及治疗对策

Related factors for hepatocirrhosis with spontaneous bacterial peritonitis and treatment countermeasures

目的探讨分析肝硬化合并自发性细菌性腹膜炎的相关因素,以便更好地治疗。方法回顾性分析64例肝硬化合并自发性细菌性腹膜炎患者的临床资料,并与46例肝硬化非自发性细菌性腹膜炎患者做对照,对比统计分析两组患者一般资料、原发病、肝功能及肝功能分级,分析研究组腹水细菌学培养结果、治疗及死亡情况。结果研究组患者男女比为3.9∶1,对照组为1.6∶1,两组差异有统计学意义(P<0.05);而年龄相比差异无统计学意义;两组原发病中均以乙型肝炎肝硬化居多,与其他原发病相比,两组差异均有统计学意义(P<0.05);丙氨酸氨基转移酶(ALT)两组相比差异无统计学意义;而总胆红素(TBIL)、总蛋白(ALB)及肝功能分级两组差异均有统计学意义(P<0.05);腹水细菌培养出病原菌68株,其中以大肠埃希菌最多,其次为肺炎克雷伯菌;研究组治疗有效率为65.6%,死亡率为21.9%,而对照组死亡率为19.6%,两组死亡率差异无统计学意义。结论肝硬化合并自发性细菌性腹膜炎与患者性别、肝炎原发病、肝功能分级及肝功能等密切相关,腹水细菌以大肠埃希菌最多见,在保肝、补充白蛋白、对症支持等治疗基础上应用敏感抗菌药物,疗效肯定,临床值得进一步研究。

OBJECTIVE To study and analyze the relevant factors for the spontaneous bacterial peritonitis combined with hepatocirrhosis , so as to provide bases for better treatment. METHODS A retrospective analysis of 64 hepatocirrhosis patients with liver cirrhosis spontaneous bacterial, peritonitis was performed, and 46 cases of patients with liver cirrhosis spontaneous bacterial peritonitis were set as control, the statistical analysis of the general data, original diseases, liver meritorious service, and liver function and the classifications of the two groups were compared, the results of ascites baeteriological culture, treatment and the mortality of the study group were analyzed. RESULTS The ratio of the men and women in the study group was 3.9 ： 1, 1.6 ： 1 in the control group, the difference was statistically significant （P〈0.05） ; the difference in the age was not statistically significant; among the primary diseases of the two groups, hepatitis B liver cirrhosis was the majority, as compared with other original diseases, the difference in the hepatitis B liver cirrhosis between the two groups was statistically significant （P〈0. 05） ; there was statistical significance in ALT of the two groups; but the differences in the TBIL, ALB and the classification of liver function between the two groups were statistically significant （P〈0.05）; of 68 strains of pathogens cultured from ascites, Escherichia coli was the majority, followed by Klebsiella pneumoniae ; the effective rate of the treatment in the study group was 65.6 %, the mortality rate in the study group was 21. 900, 19, 6G in the control group, the difference in the mortality rate between the two groups was not statistically significant. CONCLUSION Hepatocirrhosis combined with liver cirrhosis spontaneous bacterial peritonitis is closely related to the gender, hepatitis combined with primary diseases, liver function and its classification, E. coli is the major pathogen isolated from ascites, it is necessary to use sensitive antibiotics on the basis of the protection of liver, adding albumin, and symptomatic treatment, which can ensure the clinical efficacyand is worthy of being further studied in clinical practice.