摘要
目的研究慢加急性肝衰竭(ACLF)合并细菌感染患者的临床感染特点及90 d生存率的相关影响因素。方法选取2014年1月—2015年12月解放军总医院第五医学中心收治的ACLF患者,收集和分析患者的相关临床资料:感染时间及部位、微生物培养情况、生化及炎性指标、合并感染后28 d及90 d预后情况等。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。应用寿命表法绘制生存曲线。将单因素分析中对预后有影响的指标进一步行多因素logistic回归分析。结果共收治ACLF患者1074例,其中609例合并细菌感染,感染发生率为56.7%。有16例患者在90 d内行肝移植手术,其余593例均完成了相关数据统计。各部位感染占总感染人数比例分别为:腹腔70.15%、肺部41.15%、败血症11.97%、泌尿系统5.40%、胸腔4.89%,其他部位8.6%。64.76%的患者为单部位感染。微生物培养阳性率分别为:腹水22.70%、痰52.82%、尿40.63%、胸水35.71%。腹水中大肠埃希菌占首位(43.82%);痰液中肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌分别占22.67%、24.00%、22.67%;血培养中大肠埃希菌和肺炎克雷伯菌分别占33.80%、29.58%,其次为葡萄球菌(15.49%)。ACLF合并细菌感染后90 d生存率为38.11%(226/593),多因素logistic回归分析结果显示年龄(P=0.006)、肝性脑病分期(P<0.001)、肝衰竭分期(P<0.001)和急性肾损伤(P<0.001)是影响ACLF合并细菌感染患者90 d生存的独立危险因素。结论ACLF合并细菌感染发生率高,90 d生存率较低,出现急性肾损伤、Ⅲ期以上肝性脑病或肝衰竭晚期时提示预后差。
Objective To investigate the clinical features of infection in patients with acute-on-chronic liver failure(ACLF)and bacterial infection and the influencing factors for 90-day survival rate.Methods The patients with ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2015 were enrolled,and related clinical data were collected and analyzed,including infection time and site,microbial culture,biochemical parameters and inflammatory markers,and 28-and 90-day prognosis after infection.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The life-table method was used to plot survival curves.The indices affecting prognosis in the univariate analysis were further included in the multivariate logistic regression analysis.Results A total of 1074 patients with ACLF were admitted,among whom 609 had bacterial infection,and the incidence rate of bacterial infection was 56.7%.Among these 609 patients,16 underwent liver transplantation within 90 days and related data statistics were obtained for the remaining 593 patients.As for infection site,among the patients with infection,70.15%had abdominal infection,41.15%had pulmonary infection,11.97%had sepsis,5.40%had urinary system infection,4.89%had thoracic infection,and 8.6%had infection at other sites.Among the patients with infection,64.76%had infection at a single site.The positive rates of microbial culture of ascites,phlegm,urine,and pleural effusion were 22.70%,52.82%,40.63%,and 35.71%,respectively.Escherichia coli was the most common bacterium in ascites and accounted for 43.82%;Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii accounted for 22.67%,24.00%,and 22.67%,respectively,in phlegm;Escherichia coli,Klebsiella pneumoniae,and Staphylococcaceae accounted for 33.80%,29.58%,and 15.49%,respectively,in blood culture.The 90-day survival rate after infection was
作者
刘晓燕
胡瑾华
李晨
陈婧
童晶晶
关崇丹
彭宇辉
宁鹏
严立龙
苏海滨
LIU Xiaoyan;HU Jinhua;LI Chen;CHEN Jing;TONG Jingjing;GUAN Chongdan;PENG Yuhui;NING Peng;YAN Lilong;SU Haibin(Division of Liver Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第9期2148-2152,共5页
Journal of Clinical Hepatology
关键词
慢加急性肝功能衰竭
细菌感染
预后
Acute-On-Chronic Liver Failure
Bacterial Infections
Prognosis