病毒性肝炎后肝硬化住院患者感染状况调查及危险因素分析

Investigetion of the infections and assessment of the risk factors in hospitalized patients with posthepatitic cirrhosis

目的 调查病毒性肝炎后肝硬化住院患者的感染率和感染源,评估感染的危险因素.方法 采用横断面研究,连续收集382例病毒性肝炎后肝硬化住院患者,查阅患者相关临床资料,采用单因素分析、逻辑回归分析等方法分析患者感染相关因素和独立危险因素,微生物培养和鉴定分析感染源.结果 通过调查统计肝硬化住院患者感染率20.2％,77名患者感染,最常见感染是自发性细菌性腹膜炎（27例）,感染显著增加患者的死亡（22.1％vs.4.3％,P≤0.001）和延长住院时间（10 d vs.22 d,P≤0.001）.逻辑回归分析显示胃肠道出血和低白蛋白血症是肝硬化住院患者感染独立危险因素；共分离出66株菌,革兰阴性菌38株,革兰阳性菌26株,真菌2株.结论 感染增加病毒性肝炎后肝硬化住院患者死亡；胃肠道出血和低白蛋白血症是导致肝硬化住院患者感染独立危险因素.

Objective To investigate the infection rate in hospitalized patients with posthepatitic cirrhosis and to assess the risk factors of infections.Methods The prospective study was performed to assess the risk of infection in 382 hospitalized patients with posthepatitic cirrhosis.The clinical and laboratory data were collected.Univariate analysis and Logistic regression were used to analyse the risk fachors and independent risk factors of infections.Results 20.2% patients developed an infection during their hospitalization.Spontaneous bacterial peritonitis （SBP） （35.1%） were the most common infections.Death in patients with infections was higher than that of non-infection patients （22.1% vs.4.3%,P ≤ 0.001）.Logistic regression identified gastrointestinal bleeding （A =4.2,95% CI =1.8-10.7） and a low serum albumin （OR =1.4,95% CI =1.05-1.23） as the only two variables independently associated with the development of an infection.There were 66 isolates isolated including 38 gram-negtive bacteria,26 gram-positive bacteria,and 2 fungi.Conclusion Infections could increase the death rate in patients with posthepatitic cirrhosis.Patients with posthepatitic cirrhosis who were admitted for gastrointestinal bleeding and low serum albumin level have a higher risk of developing a infection during their hospitalization than other cirrhotic patients.