乙型肝炎肝硬化患者并发革兰阳性菌感染自发性细菌性腹膜炎特征分析

Predictive factors of spontaneous bacterial peritonitis of Gram-positive bacteria in hepatitis B patients

目的探讨革兰阳性、阴性细菌感染所致SBP的影响因素。方法2015年10月至2020年2月淮安第一医院收治的乙型肝炎肝硬化并发自发性细菌性腹膜炎(SBP)患者116例,根据腹水培养结果分为革兰阳性菌、阴性菌组。搜集菌群特征,比较革兰阳性、阴性组临床资料,同时分析乙型肝炎肝硬化并发SBP患者革兰阳性细菌感染影响因素。结果116例乙型肝炎肝硬化并发SBP患者中,革兰阳性菌感染41例(35.3%)、革兰阴性菌感染75例(64.7%)。前者菌群包括肠球菌属16株(13.8%)、金黄色葡萄球菌13株(11.2%)、气单胞菌属10株(8.6%)以及链球菌属2株(1.7%);后者菌群包括大肠杆菌40株(34.5%)、肺炎克雷伯菌27株(23.3%)、铜绿假单胞菌6株(5.2%)以及雷普罗威登斯菌2株(1.7%)。革兰阳性菌组Child-Pugh评分、MELD评分及SOFA评分分别为(7.9±1.8)分、(18.0±5.8)分及(4.7±1.8)分,均低于革兰阴性菌组的(9.7±2.1)分、(22.4±7.0)分及(6.7±2.1)分,(P<0.05);革兰阳性菌、阴性菌组1个月内接受抗菌药物治疗分别为20例(48.8%)、18例(24.0%),差异有统计学意义(P<0.05);而两组年龄、性别、BMI、血清学、腹水指标以及28 d病死率差异无统计学意义(P>0.05)。经多因素分析,1个月内接受抗菌药物治疗和SOFA评分是SBP革兰阳性细菌感染的独立影响因素(P<0.05)。结论乙型肝炎肝硬化并发SBP患者中革兰阳性菌感染增加,1月内接受抗菌药物治疗、低SOFA评分与肝硬化患者革兰阳性菌引起的SBP显著相关。

Objective To determine the influencing factors of spontaneous bacterial peritonitis(SBP)caused by Gram-positive and Gram-negative bacterial infections.Methods From October 2015 to February 2020,116 patients with hepatitis B cirrhosis complicated with SBP were admitted to our hospital,including 92 males and 24 females.The average age was(57.6±7.2).According to the results of ascites culture,they were divided into Gram-positive and Gram-negative groups.The diagnosis of hepatitis B and SBP met the requirements.The flora characteristics were compared between the Gram-positive and Gram-negative groups,and the influencing factors of Gram-positive bacterial infection in patients with hepatitis B cirrhosis complicated with SBP were further analyzed.Results Among 16 patients with hepatitis B cirrhosis complicated with SBP,41 cases(35.3%)were infected by Gram-positive bacteria and 75 cases(64.7%)were by Gram-negative bacteria.The former included 16 cases of Enterococcus(13.8%),13 cases of Staphylococcus aureus(11.2%),10 cases of Aeromonas(8.6%)and 2 cases of Streptococcus(1.7%).The latter included 40 cases of Escherichia coli(34.5%),27 cases of Klebsiella pneumoniae(23.3%),6 cases of Pseudomonas aeruginosa(5.2%),and 2 cases of Providence reyi(1.7%).In Gram-positive groups,Child-Pugh score,MELD score and SOFA score of gram-positive group were(7.9±1.8),(18.0±5.8)and(4.7±1.8),respectively,which were significantly lower than those in gram-negative group[(9.7±2.1),(22.4±7.0)and(6.7±2.1),with statistically significant difference(P<0.05).Furthermore,20 cases(48.8%)and 18 cases(24.0%)in Gram-positive and Gram-negative groups received antimicrobial therapy within one month,respectively,with statistically significant difference(P<0.05).There was no significant difference in age,sex,BMI,serology,ascites index and 28-day mortality between the two groups(P>0.05).By multivariate analysis,antimicrobial therapy within one month and SOFA score were the independent influencing factors of SBP Gram-positive bacterial infection(P<0.05).Conclusion Similarly to the previous studies,the SBP caused by Gram-positive bacteria in patients with liver cirrhosis was significantly related to antimicrobial therapy within one month before SBP diagnosis and low SOFA score.Therefore,it is necessary to consider these factors when diagnosing and treating patients with cirrhosis and SBP.