肝硬化患者食管静脉曲张硬化剂治疗术后感染的相关研究

Study on postoperative infection of endoscopic injection sclerotherapy in patients with liver cirrhosis

目的探讨肝硬化食管静脉曲张患者行内镜下硬化剂治疗(endoscopic injection sclerotherapy,EIS)术后感染的发生率、影响因素及诊断标志物。方法回顾性分析首都医科大学附属北京佑安医院肝病消化中心2016年10月至2018年9月收治的471例肝硬化食管静脉曲张患者的临床资料。所有患者均行胃镜下注射聚桂醇治疗食管静脉曲张。按照术后是否发生感染分为感染组与非感染组。分析两组患者的血常规、C反应蛋白、降钙素原、凝血酶原活动度、D-二聚体及肝脏炎症指标。感染组患者给予静脉输注头孢噻肟钠舒巴坦钠,观察治疗效果。结果471例患者EIS术后41例(8.7%)发生感染。感染组术前凝血酶原活动度为(65.96±12.15)%,明显低于非感染组的(72.40±12.72)%,差异有显著性(P=0.03)。与非感染组比较,术后感染组白细胞计数、中性粒细胞百分比、降钙素原和C反应蛋白水平均升高,差异有显著性(P<0.05);感染组术后D-二聚体水平为(1832.2±316.6)mg/L,显著高于非感染组的(1050.1±277.3)mg/L,差异有显著性(P=0.02)。感染组患者应用头孢噻肟舒巴坦钠治疗后,感染均可得到控制。结论肝硬化食管静脉曲张患者EIS术后发生感染者术前凝血酶原活动度水平较低,临床应予以重视并提前进行干预。术后D-二聚体水平可能是EIS术后并发感染有价值的诊断标志物。静脉输注头孢噻肟钠舒巴坦钠可有效控制常规内镜下EIS术后感染。

Objective To investigate the incidence,related factor and diagnostic marker of infection after endoscopic injection sclerotherapy(EIS)in liver cirrhosis.Method 471 patients with liver cirrhosis and esophageal varices who were admitted to the Liver Disease and Digestion Center of Beijing You’an Hospital,Capital Medical University from October 2016 to September 2018 were selected as the research objects.All patients underwent gastroscopic injection of cinnamyl alcohol to treat esophageal varices.We analyzed the patient’s blood routine,CRP,PCT,prothrombin activity,D-dimer and other biochemical indicators.Result There were 41 infected patients after EIS,accounting for 8.7%of all patients.The preoperative PTA of the infected group was significantly lower than that of the non-infected group[(65.96±12.15)vs(72.40±12.72),P=0.03].After operation,compared with the non-infected group,WBC,NEUT%,PCT and CRP were increased in the infected group,and the difference were statistically significant(P<0.05);in addition,the D-dimer in the infected group was also significantly higher than that in the non-infected group[(1832.2±316.6)vs(1050.1±277.3),P=0.02].After treatment with cefotaxime and sulbactam sodium in the infected group,the infection can be controlled.Conclusion Compared with the non-infected group after EIS in patients with liver cirrhosis,there are statistical differences in PTA before operation and D-dimer after operation.The application of cefotaxime and sulbactam sodium can effectively control infection after EIS.