细菌感染诱发肝性脑病的乙型肝炎肝硬化患者临床特点分析

Clinical features of hepatic encephalopathy induced by bacterial infection in patients with hepatitis B virus-related cirrhosis

目的分析细菌感染诱发肝性脑病的乙型肝炎肝硬化患者的临床特点。方法回顾性分析186例乙型肝炎肝硬化合并肝性脑病患者的临床资料,根据是否存在细菌感染的诱因将患者分为感染组(59例)和非感染组(127例)。观察两组血氨、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、国际标准化比率(INR)、白细胞(WBC)、中性粒细胞百分比、肌酐(Cr)、病死率。结果感染组血氨(113.7±63.0)μmol/L,ALT(206.3±86.4)U/L,TBIL(113.7±62.9)mmol/L,WBC(11.0±7.3)×109/L,中性粒细胞百分比79.6%±6.6%,Cr(118.2±91.4)μmol/L,Child-Pugh分级(13±1)分,病死率为40.6%。非感染组血氨(80.9±40.7)μmol/L,ALT(114.2±20.9)U/L,TBIL(80.9±40.7)mmol/L,WBC(6.6±4.8)×109/L,中性粒细胞百分比61.4%±6.9%,Cr(72.9±34.3)μmol/L,Child-Pugh分级(10±1)分,病死率为28.3%,两组比较,P均<0.05。结论细菌感染诱发肝性脑病的乙型肝炎肝硬化患者肝损害重,血氨、WBC、中性粒细胞百分比、病死率高。

Objective To analyze the clinical features of hepatic encephalopathy （ HE） induced by bacterial infection in patients with hepatitis B virus （ HBV）-related cirrhosis.Methods A total of 186 cases of patients with HBV-related cirrhosis and HE were divided into the infection group （59 cases） and non-infection group （127 cases） according to wheth-er the presence of bacterial infections.We observed the blood ammonia, serum albumin （ ALB） , alanine aminotransferase （ ALT） , total bilirubin （ TBIL） , international normalized ratio （ INR） , white blood cell （ WBC） , the percentage of neutro-phile granulocyte, serum creatinine （ Cr） and the mortality rate in the two groups.Results In the infection group, ammo-nia was （113.7 ±63.0）μmol/L, ALT was （206.3 ±86.4） U/L, TBIL was （113.7 ±62.9） mmol/L, WBC was （11.0 ±7.3） ×109/L, the percentage of neutrophile granulocyte was 79.6%±6.6%, Cr was （118.2 ±91.4） μmol/L, the Child-Pugh scores were （13 ±1） scores and the mortality rate was 40.6%.In the non-infection group, ammonia was （80.9 ±40.7） μmol/L, ALT was （114.2 ±20.9） U/L, TBIL was （80.9 ±40.7） mmol/L, WBC was （6.6 ±4.8） × 109/L, the percentage of neutrophile granulocyte was 61.4%±6.9%, Cr was （72.9 ±34.3） μmol/L, Child-Pugh scores were （10 ±1） scores and the mortality rate was 28.3%.Significant differences were found in the above indexes between the two groups （ all P〈0.05） .Conclusions Serious liver damage is found in patients with HBV-related cirrhosis and HE induced by bacterial infection.Meanwhile, the patients have high ammonia, WBC, the percentage of neutrophile granulo-cyte levels and high mortality rate.