症状性细菌性腹水快速筛查模型指导抗生素治疗的随机对照临床研究

Randomized controlled clinical trials of a quick screening model for symptomatic bacterascites for guided antibiotic therapy

目的探讨症状性细菌性腹水快速筛查模型指导抗生素治疗的临床意义。方法2016年9月至2017年2月,前瞻性收集南昌市第九医院新收治住院的肝硬化腹水患者24例,其腹水多形核细胞计数<250个/mm3,无明确抗生素治疗指征,但被症状性细菌性腹水快速筛查模型判为阳性。随机分为试验组12例和对照组12例,试验组全程接受抗生素治疗,对照组不予抗生素治疗,治疗第10天为研究终点,比较两组的治疗应答情况。治疗应答结果分为完全应答、部分应答和无应答,应答率为完全与部分应答率之和。治疗应答情况的组间比较采用Mann-WhitneyU检验和Fisher精确概率法。结果两组性别、年龄、筛查评分及病情严重程度等基线情况一致(P>0.05)。治疗第10天,试验组与对照组的完全应答例数为1比0、部分应答例数为7比2、无应答例数为4比10,Z=-2.467,P=0.014;试验组应答率明显优于对照组,为66.7%(8/12)比16.7%(2/12),P=0.036。结论症状性细菌性腹水快速筛查模型对抗生素治疗具有一定指导意义,被该模型判为阳性的肝硬化腹水患者接受抗生素治疗可获益。

Objective To investigate the clinical significance of a quick screening model for symptomatic bacterascites for guided antibiotic therapy.Methods Data were collected prospectively from 24 cases of cirrhotic ascites who were newly admitted to Nanchang Ninth Hospital between September 2016 and February 2017.No clear indication for antibiotic treatment was used when the number of polymorphonuclear cells in ascites was<250 cells/mm3.A quick screening model for symptomatic bacterascites was determined by positivity and was randomly divided into the experimental(12 cases)and the control group(12 cases).The experimental group was given antibiotic treatment during the whole process,while the control group did not receive antibiotic treatment.The 10th day of treatment was the end point of the study.The treatment responses of the two groups were compared.The treatment response results were divided into three categories:complete response,partial response,and no response.The sum of complete and partial response rates was used to determine the response rate.The Mann-Whitney U test and Fisher's exact test were used to compare the treatment responses between groups.Results The baseline conditions of gender,age,screening score,and disease severity were consistent between the two groups(P>0.05).On the 10th day of treatment,the number of complete responses between the experimental group and the control group was 1 to 0,the number of partial responses was 7 to 2,and the number of non-responses was 4 to 10,Z=-2.467,P=0.014.The response rate was significantly better in the experimental group than in the control group[66.7%(8/12)vs.16.7%(2/12),P=0.036].Conclusion Guided antibiotic therapy is somehow important for the quick screening model for symptomatic bacterascites,and patients with cirrhotic ascites who test positive in this model can benefit from antibiotic therapy.