肝硬化腹水并发自发性细菌性腹膜炎的危险因素分析

Analysis on the risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites

目的探讨肝硬化腹水并发自发性细菌性腹膜炎(SBP)的危险因素。方法选择40例肝硬化腹水并发SBP和28例未并发SBP的肝硬化腹水患者作为研究对象,采取回顾性研究的方法对相关临床资料进行分析。结果肝硬化腹水并发SBP者在并发休克、肝肾综合征、原发性肝癌、上消化道出血以及年龄区间、多次住院、既往是否发生腹水等方面与不合并SBP患者差异具有统计学意义(P均<0.05);两组患者的外周血TBil、ALB、PT、CR、UA以及血钠表达水平差异具有统计学意义(P均<0.05)。患者年龄、TBil、ALB、PT、血钠和CR作为可作为单因素预测肝硬化腹水并发SBP发生(P均<0.05)。多因素Logistic回归分析结果发现,TBil、ALB以及是否合并原发性肝癌两组间差异具有统计学意义(P均<0.05)。结论高胆红素血症、低蛋白血症以及合并原发性肝癌为肝硬化腹水患者并发SBP的危险因素,对这类患者应及时预防性使用抗菌药物。

Objective To investigate the risk factors of spontaneous bacterial peritonitis（SBP） in cirrhotic patients with ascites. Methods Total of 40 patients with SBP and 28 no-SBP in cirrhotic patients with ascites were collected, respectively. The clinical data were analyzed, retrospectively. Results The incidence of shock, hepatorenal syndrome, primary liver cancer, upper gastrointestinal bleeding, several times being hospitalized, previous ascites were significantly different between in SBP and non-SBP in cirrhotic patients with ascites（P all 〈0.05）. The distribution of age, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, total bilirubin（TBil）, albumin（ALB）, creatinine（CR）, prothrombin time（PT） and serum sodium between the two groups were all with significant differences（P all 〈0.05）. The age, TBil, ALB, PT, serum sodium, CR and hepatorenal syndrome, primary liver caner, upper gastrointestinal bleeding and several times being hospitalized were the risk factors for SBP in cirrhotic patients with acites, tested by univariate analysis（P all 〈0.05）. But if multivariate Logistic regression analysis results showed only TBil, ALB and the incidence of primary liver cancer were difference between SBP and non-SBP in cirrhosis patients with ascites（P all 〈0.05）. Conclusions Hyerbilirubinemia, hyporotinemia and the incidence of primary liver cancer were the risk factors of SBP in cirrhotic patients with ascites. If patients had these factors, antibiotic prophylaxis should be given.