中性粒细胞CD64对自发性细菌性腹膜炎抗生素应用的指导价值

Value of neutrophil CD64 in guiding antibiotic therapy for spontaneous bacterial peritonitis

目的探讨中性粒细胞CD64对乙肝肝硬化并发自发性细菌性腹膜炎(SBP)应用抗生素的指导价值。方法将134例乙肝肝硬化并发SBP患者随机分为CD64组(73例)和对照组(61例),CD64组根据中性粒细胞CD64作为开始和停用抗生素的依据;对照组按照常规方法应用抗生素。比较两组患者的抗生素疗程、抗生素费用、住院时间、住院费用、Child-Pugh评分、MELD评分、临床有效率及病死率。结果 CD64组抗生素疗程8 d(6~14 d)、抗生素费用781元(458~4 297元)、住院时间15 d(6~29 d)、住院费用7 328元(4 951~13 916元)均低于对照组分别为11 d(7~20 d),1 084元(728~5 822元),20 d(10~35 d),10 239元(5 325~19 824元)。治疗结束后CD64组与对照组患者Child-pugh评分[(9.26±3.24)vs(9.72±3.12)]、MELD评分[(16.16±8.04)vs(15.71±8.13)]、临床有效率(90.41%vs 91.80%)和病死率(4.11%vs 3.28%)比较,均差异无统计学意义(均P>0.05)。结论中性粒细胞CD64可作为乙肝肝硬化并发SBP患者临床抗生素应用的参考指标,并能够缩短抗生素使用时间和住院天数。

Objective To evaluate the value of neutrophil CD64 in guiding the antibiotic therapy for hepatitis B liver cirrhosis complicated with spontaneous bacterial peritonitis （SBP）. Methods Totally 134 patients with hepatitis B liver cirrhosis complicated with SBP were randomly divided into CD64 group （73 cases） and control group （61 cases）. The patients in the CD64 group received antibiotics according to neutrophil CD64, and the patients in the control group were treated according to the clinical symptoms, the plasma level of white blood cell and antibiotic guidelines. The main observation indexes included duration of antibiotic therapy, cost of antibiotics, length of hospitalization, cost of hospitalization, Child-Pugh score, MELD score, clinical efficacy and mortality. Results The duration of antibiotic therapy and the length of hospitalization were shorter, the cost of antibiotics and the cost of hospitalization were lower in the CD64 group than in the control group （P〈 0.05）. There was no significant difference in the Child-Pugh score, the MELD score, the clinical efficacy or the mortality between the two groups after treatment （P 〉 0.05）. Conclusions The neutrophil CD64 can be used as a reference index to guide clinical antibiotic application for hepatitis B liver cirrhosis complicated with SBP, and can shorten the duration of antibiotic use and length of hospitalization.