肝硬化合并肺部感染的病原菌分布及危险因素分析

Analysis of Distribution and Risk Factors of Pathogenic Bacteria in Liver Cirrhosis Complicated with Pulmonary Infection

目的:分析肝硬化合并肺部感染的病原菌分布及危险因素。方法:选取2013年2月到2018年7月期间我院接受治疗的肝硬化患者518例,统计所有患者中并发肺部感染的例数,收集患者的临床资料,包括性别、年龄、病因、住院时间、是否有侵入性操作、是否有腹水、Child-Pugh分级、是否有上消化道出血、是否有合并基础疾病等临床资料,分析肺部感染与患者的各项临床资料的关系,并检测肝硬化合并肺部感染的病原菌分布情况,采用多因素Logistic回归分析肝硬化患者发生肺部感染的危险因素。结果:518例肝硬化患者中有80例发生肺部感染,发生率为15.44%。单因素分析显示,性别与肝硬化患者发生肺部感染无关(P>0.05),年龄、病因、住院时间、侵入性操作、腹水、Child-Pugh分级、上消化道出血、合并基础疾病均是肝硬化患者发生肺部感染的影响因素(P<0.05)。多因素Logistic回归分析显示,年龄芏60岁、住院时间芏2周、有侵入性操作、有腹水、Child-Pugh分级为C级、有上消化道出血、合并基础疾病均是肝硬化患者发生肺部感染的危险因素(P<0.05)。80例肝硬化患者合并肺部感染患者的痰液标本中共检出病原菌93株,其中革兰阴性菌51株,占比54.84%,革兰阳性菌37株,占比39.78%,真菌5株,占比5.38%。结论:肝硬化合并肺部感染的主要病原菌为革兰阳性菌和革兰阴性菌,且肺部感染的危险因素较多,临床上应根据其危险因素做好相对应的防治措施,以减少肺部感染的发生。

Objective: To analyze the distribution and risk factors of pathogenic bacteria in liver cirrhosis complicated with pulmonary infection. Methods: 518 patients with liver cirrhosis who were treated in our Hospital from February 2013 to June 2018 were selected. The number of pulmonary infection in all patients was counted. The clinical data of the patients were collected,including gender, age, etiology, length of stay, with or without invasive operations, with or without ascites, Child-Pugh classification,with or without upper gastrointestinal bleeding and with or without the combination of basic diseases. The relationship between pulmonary infection and clinical data was analyzed, the distribution of pathogenic bacteria in patients with liver cirrhosis complicated with pulmonary infection was also detected, and multivariate logistic regression analysis was used to analyze the risk factors of pulmonary infection in patients with liver cirrhosis. Results: Among 518 patients with liver cirrhosis, 80 cases had pulmonary infection,the incidence rate was 15.44%. Univariate analysis showed that gender was not associated with lung infection in patients with cirrhosis(P>0.05). Age, etiology, length of stay, invasive operations, ascites, Child-Pugh classification, upper gastrointestinal bleeding and combined basic diseases were all the factors affecting the pulmonary infection in the patients with liver cirrhosis(P<0.05). Multivariate logistic regression analysis showed that age ≥60 years old, length of stay ≥2 weeks, with invasive operations and ascites, Child-Pugh classification with C grade, with upper gastrointestinal bleeding and combined basic disease were all risk factors for pulmonary infection in patients with liver cirrhosis(P<0.05). A total of 93 strains of pathogenic bacteria were detected in sputum samples from 80 patients with liver cirrhosis and pulmonary infection, including gram-negative bacteria with 51 strains, accounting for 54.84%,gram-positive bacteria with 37 strains, accounting for 39.78%, and fungi with 5 strains, accounting for 5.38%. Conclusion: The main pathogenic bacteria of liver cirrhosis complicated with pulmonary infection are Gram-positive bacteria and Gram-negative bacteria, and there are more risk factors for pulmonary infection. In clinically, corresponding preventive measures should be taken according to their risk factors to reduce the occurrence of pulmonary infection.