慢加急性肝衰竭患者发生肺部感染的临床特点及预后分析

Clinical features and prognostic analysis of pulmonary infection in patients with acute-on-chronic liver failure

目的分析HBV相关慢加急性肝衰竭患者发生肺部感染的临床特点及预后的影响因素。方法选取2018年3月至2019年1月就诊于珠海市人民医院的HBV相关慢加急性肝衰竭(HBV-ACLF)患者75例,其中合并肺部感染37例,未合并肺部感染38例。分析两组患者的并发症发生情况,检测胆固醇、血清钠、甲胎蛋白、白蛋白、PTA、C反应蛋白等6项生化指标,Child-Pugh评分评估患者预后,分析生化指标与预后的相关性。结果合并肺部感染组患者凝血功能障碍、上消化道出血、肝性脑病及肝肾综合征的发生分别为9例(24.3%)、12例(32.4%)、10例(27%)和9例(24.3%),高于非合并肺部感染组的1例(2.6%)、2例(5.3%)、2例(5.3%)和1例(2.6%),差异均有统计学意义(均P<0.05),腹水的发生率则差异无统计学意义。血清生化指标结果显示,与未合并肺部感染组患者相比,合并肺部感染的患者的血清胆固醇、血清钠、甲胎蛋白、白蛋白、PTA的表达水平下降,CRP及PCT则明显增高,差异有统计学意义(P<0.05)。未合并肺部感染组Child-Pugh评分为(5.3±0.43)分,合并肺部感染组为(8.6±3.3)分,差异有统计学意义(P<0.01)。Spearman相关性分析结果表明,Child-Pugh评分与CRP及PCT含量呈正相关,与胆固醇、血清钠、甲胎蛋白、白蛋白及PTA呈负相关。结论慢加急性肝衰竭患者发生肺部感染时可加重患者症状,影响患者预后,胆固醇、血清钠、血清白蛋白、C反应蛋白、PTA、甲胎蛋白及PCT可能是影响HBV-ACLF合并肺部感染患者预后的重要因素。

Objective To analyze the clinical characteristics and prognostic factors of HBV-related chronic acute liver failure patients with lung infection.Methods A total of 75 HBV-related chronic acute liver failure(HBV-ACLF)patients who were admitted to our hospital from March 2018 to January 2019 were selected and divided into the lung infection group(lung infection,LI)according to whether they had pulmonary infection.37 cases in the group and 38 cases in the no lung infection(NLI)group.Collect and analyze the complications of the two groups of patients,check the six biochemical indicators of cholesterol,serum sodium,alpha-fetoprotein,albumin,PTA,and C-reactive protein in the two groups,use the Child-Pugh score to assess the prognosis of the patients,and analyze the two The correlation between biochemical indicators and prognosis of patients in the group.Results Compared with the NLI group,the incidence of coagulation dysfunction,upper gastrointestinal hemorrhage,hepatic encephalopathy,and hepatorenal syndrome in the LI group increased significantly,and the difference was statistically significant(P<0.05),while the incidence of ascites was higher There is no statistical difference.Serum biochemical index results showed that compared with patients without lung infection,the expression levels of serum cholesterol,serum sodium,alpha-fetoprotein,albumin,and PTA in patients with lung infection decreased,while CRP and PCT were significantly increased.The difference was statistically significant(P<0.05).The Child-Pugh score results showed that the average Child-Pugh score of the non-pulmonary infection group was 5.3±0.43 points,and the score of the combined lung infection group was 8.6±3.3 points.There was a significant difference between the two(P<0.01).The results of Spearman correlation analysis showed that Child-Pugh score was positively correlated with CRP and PCT content,and the correlation was statistically significant(P<0.0001).Child-Pugh scores are negatively correlated with cholesterol,serum sodium,alpha-fetoprotein,albumin and PTA,and the correlations are statistically significant(cholesterol P<0.05,serum sodium,alpha-fetoprotein,albumin and PTAP<0.0001).Conclusion Pulmonary infection in patients with chronic acute liver failure can aggravate the symptoms and affect the prognosis of the patients.The expression of cholesterol,serum sodium,serum albumin,C-reactive protein,PTA,alpha-fetoprotein and PCT may affect the combination of HBV-ACLF An important factor for the prognosis of patients with lung infection.