失代偿期肝硬化并发败血症患者临床特征及其危险因素分析

Clinical features and risk factors of patients with decompensated cirrhosis and sepsis

目的探讨失代偿期肝硬化并发败血症患者的临床特点及危险因素。方法2014年6月~2018年7月我院诊治的68例失代偿期肝硬化患者,并发败血症患者30例,应用Logistic回归分析影响肝硬化患者并发败血症的相关因素。结果在30例肝硬化并发败血症患者中,检出病原菌30例,其中革兰氏阴性细菌19例(肺炎克雷伯菌8例,大肠埃希菌6例,其他革兰氏阴性细菌5例),检出革兰氏阳性细菌11例(金黄色葡萄球菌5例,草绿色链球菌2例,其他革兰氏阳性细菌4例);肝硬化并发败血症患者中性粒细胞百分比为(74.34±2.88)%,血肌酐(Cr)为(126.57±20.81)μmol/L,C反应蛋白(CRP)为(48.93±10.28)mg/l,总胆红素(TBIL)水平为(82.29±16.59)μmol/L,均显著高于肝硬化组【分别为(58.53±2.91)%、(74.69±3.24)μmol/L、(24.21±6.66)mg/l和(52.93±11.03)μmol/L,P<0.05】,而血清白蛋白(ALB)水平为(27.21±5.66)g/L,显著低于对照组【(31.83±7.98)g/L,P<0.05】;经Logistic回归分析,发现血清总胆红素和白蛋白水平是影响并发败血症的独立危险因素。结论失代偿期肝硬化患者并发败血症以革兰氏阴性杆菌感染为主,了解其发生的危险因素并给予积极的预防,可能改善患者的预后。

Objective To investigate the clinical features and risk factors of patients with decompensated cirrhosis and sepsis.Methods 68 patients with decompensated liver cirrhosis were enrolled in our hospital between 2014 and 2018,and 30 patients were diagnosed with sepsis.Logistic regression analysis was applied to find the affecting risk factors for the occurrence of sepsis.Results Out of the 30 patients with sepsis,30 cases of pathogenic bacteria were detected,including 19 cases of gram-negative bacteria(Klebsiella pneumonia in 8,E.Coli in 6,and 5 cases of other gram-negative bacteria).Eleven cases of gram-positive bacteria were detected(Staphylococcus aureus in 5,Streptococcus viridians in 2 and 4 cases of other gram-positive bacteria).In patients with sepsis,the percentage of neutrophil was(74.34±2.88)%,blood creatinine level was(126.57±20.81)μmol/L,CRP was(48.93±10.28)mg/l,serum bilirubin level was(82.29±16.59)μmol/L,all significantly different compared to[(58.53±2.91)%,(74.69±3.24)μmol/L,(24.21±6.66)mg/l and(52.93±11.03)μmol/L,P<0.05]in patients without sepsis,while serum albumin level was(27.21±5.66)g/L,much lower than【(31.83±7.98)g/L,P<0.05】in the control;Logistic regression analysis showed that serum bilirubin and albumin levels were the independent risk factors for the occurrence of sepsis.Conclusion The common pathogen in deconpensated liver cirrhosis patients with sepsis is gram-negative bacillus,and the clinicians should take risk factors into consideration in this settings.