肝硬化患者自发性肠球菌性腹膜炎的临床研究

Clinical study on cirrhotic patients with spontaneous enterococcal peritonitis

目的探讨肝硬化患者发生自发性肠球菌性腹膜炎(SEP)的危险因素、临床特点及预后。方法搜集2005年1月至2011年7月收住杭州市第六人民医院的自发性细菌性腹膜炎(SBP)患者共332例进行回顾性分析,其中肝硬化并发SEP患者(SEP组)30例,其他病原体所致SBP患者(对照组)302例。分别评估两组患者的临床特点及预后。结果与对照组相比,SEP组中有近期胃肠道出血史、3月内应用抗菌药物史、近期胆道感染史、腹部手术史或中心静脉置管史的患者较多,且肝功能Child-pugh评分较低(P均<0.05)。其中,7 d内上消化道出血为发生SEP的独立危险预测因素(β=1.621,RR=5.3,P=0.005)。SEP组30 d病死率(43.3%,13/30)远远高于对照组(18.9%,57/302)(χ2=9.812,P=0.002),而感染性休克是SEP组患者死亡的独立危险预测因子(β=-3.25,RR=8.7,P=0.004)。结论肝硬化患者并发SEP预后较差。近期有胃肠道出血提示患者为肠球菌感染,应注意预防并及时治疗感染性休克。

Objective To investigate the risk factors, clinical characteristics and prognosis of spontaneous enterococcal peritonitis （SEP） in cinlhotic patients. Methods The retrospective cohort study was conducted in cirrhotic patients with ascites admitted to our hospital from January 2005 to July 2011. A total of 332 cases presented with spontaneous bacterial peritonitis （SBP） were enrolled in the study, including 30 cirrhotic patients with SEP （SEP group） and 302 cases with SBP which caused by other bacterial infections （control group）. The clinical manifestations and prognosis of the two groups were evaluated respectively. Results Statistical differences were noted in recent upper gastrointestinal bleeding or biliary infections, antibiotics within three months, history of abdominal surgeries or central venous catheter placement between the two groups （all P 〈 0.05）. Compared with the control group, Child-pugh scores were significantly lower in the SEP group （P 〈 0.05）.Upper gastrointestinal bleeding within 7 days was an independent high-risk prognostic factor for cirrhotic patients with SEP （β = 1.621, RR = 5.3, P= 0.005）. The 30-day mortality in the SEP group was obviously higher than that in the control group （43.3% vs 18.9%）（x2 = 9.812, P= 0.002）, and septic shock was an independent prognostic factor for mortality in cirrhotic patients with SEP （β =-3.25, RR = 8.7, P = 0.004）. Conclusions The prognosis of cirrhotic patients with SEP was poor. The recent gastrointestinal bleeding may indicate enterococci infection in patients, thereby septic shock should be prevented and cured in time.