Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit ...Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit with steady prevalence and a high recurrencerate. Bacterial translocation,the key mechanism in thepathogenesis of SBP,is only possible because of theconcurrent failure of defensive mechanisms in cirrhosis.Variants of SBP should be treated. Leucocyte esterasereagent strips have managed to shorten the 'tap-to-shot' time,while future studies should look into theircombined use with ascitic fluid pH. Third generationcephalosporins are the antibiotic of choice becausethey have a number of advantages. Renal dysfunctionhas been shown to be an independent predictor ofmortality in patients with SBP. Albumin is felt to reducethe risk of renal impairment by improving effectiveintravascular volume,and by helping to bind pro-inflammatory molecules. Following a single episodeof SBP,patients should have long-term antibioticprophylaxis and be considered for liver transplantation.展开更多
目的探讨红细胞分布宽度(red cell distribution width,RDW)对乙型肝炎肝硬化失代偿及并发消化道出血的临床评估价值.方法选取2017年1月至2018年12月宿迁市人民医院感染科收治的232例乙型肝炎肝硬化患者,回顾性分析其血常规及生物化学...目的探讨红细胞分布宽度(red cell distribution width,RDW)对乙型肝炎肝硬化失代偿及并发消化道出血的临床评估价值.方法选取2017年1月至2018年12月宿迁市人民医院感染科收治的232例乙型肝炎肝硬化患者,回顾性分析其血常规及生物化学各参数指标在乙型肝炎肝硬化代偿期和失代偿期患者中的特点,以logistic回归分析失代偿期肝硬化及并发消化道出血的变化指标,以受试者操作特征曲线下面积评估各项指标的临床意义及诊断价值.结果乙型肝炎肝硬化代偿期进展至失代偿期乃至并发消化道出血患者的血小板计数、血红蛋白水平、淋巴细胞计数逐渐降低,3组间比较差异有统计学意义(P<0.05).RDW在乙型肝硬化代偿期、失代偿期非消化道出血和失代偿期并发消化道出血患者中分别为12.60%(12.10%,13.38%)、15.25%(13.98%,16.63%)和17.25%(15.20%,21.28%),3组间两两比较差异均有统计学意义(均P<0.05).多因素logistics回归分析结果显示,RDW、红细胞是乙型肝炎肝硬化失代偿及并发消化道出血的独立相关因素(P<0.01);RDW、天冬氨酸转氨酶与血小板比值(aspartate aminotransferase-to-platelet ratio,APRI)、红细胞分布宽度与血小板计数比值(red blood cell distribution width to platelet ratio,RPR)均与Child-Pugh评分有较强的相关性,其中RDW与Child-Pugh评分呈正相关(r=0.739,P<0.01)且相关性最高,与终末期肝病模型评分亦具有相关性(r=0.367,P<0.01),但相关性较其他评估指标无明显优势;在诊断乙型肝炎肝硬化失代偿及消化道出血方面,RDW的受试者操作特征曲线下面积分别为0.920、0.883,灵敏度分别为81.7%、83.8%,特异度分别为85.9%、78.5%,均高于其他无创性评估指标.结论RDW与乙型肝炎肝硬化失代偿及并发消化道出血相关,是了解肝硬化患者病情进展严重程度的重要参考指标,在评估肝硬化患者有无出血倾向中有一定的临床价值.展开更多
文摘Since its initial description in 1964,research hastransformed spontaneous bacterial peritonitis (SBP)from a feared disease (with reported mortality of 90%)to a treatable complication of decompensated cirrhosis,albeit with steady prevalence and a high recurrencerate. Bacterial translocation,the key mechanism in thepathogenesis of SBP,is only possible because of theconcurrent failure of defensive mechanisms in cirrhosis.Variants of SBP should be treated. Leucocyte esterasereagent strips have managed to shorten the 'tap-to-shot' time,while future studies should look into theircombined use with ascitic fluid pH. Third generationcephalosporins are the antibiotic of choice becausethey have a number of advantages. Renal dysfunctionhas been shown to be an independent predictor ofmortality in patients with SBP. Albumin is felt to reducethe risk of renal impairment by improving effectiveintravascular volume,and by helping to bind pro-inflammatory molecules. Following a single episodeof SBP,patients should have long-term antibioticprophylaxis and be considered for liver transplantation.
文摘目的探讨红细胞分布宽度(red cell distribution width,RDW)对乙型肝炎肝硬化失代偿及并发消化道出血的临床评估价值.方法选取2017年1月至2018年12月宿迁市人民医院感染科收治的232例乙型肝炎肝硬化患者,回顾性分析其血常规及生物化学各参数指标在乙型肝炎肝硬化代偿期和失代偿期患者中的特点,以logistic回归分析失代偿期肝硬化及并发消化道出血的变化指标,以受试者操作特征曲线下面积评估各项指标的临床意义及诊断价值.结果乙型肝炎肝硬化代偿期进展至失代偿期乃至并发消化道出血患者的血小板计数、血红蛋白水平、淋巴细胞计数逐渐降低,3组间比较差异有统计学意义(P<0.05).RDW在乙型肝硬化代偿期、失代偿期非消化道出血和失代偿期并发消化道出血患者中分别为12.60%(12.10%,13.38%)、15.25%(13.98%,16.63%)和17.25%(15.20%,21.28%),3组间两两比较差异均有统计学意义(均P<0.05).多因素logistics回归分析结果显示,RDW、红细胞是乙型肝炎肝硬化失代偿及并发消化道出血的独立相关因素(P<0.01);RDW、天冬氨酸转氨酶与血小板比值(aspartate aminotransferase-to-platelet ratio,APRI)、红细胞分布宽度与血小板计数比值(red blood cell distribution width to platelet ratio,RPR)均与Child-Pugh评分有较强的相关性,其中RDW与Child-Pugh评分呈正相关(r=0.739,P<0.01)且相关性最高,与终末期肝病模型评分亦具有相关性(r=0.367,P<0.01),但相关性较其他评估指标无明显优势;在诊断乙型肝炎肝硬化失代偿及消化道出血方面,RDW的受试者操作特征曲线下面积分别为0.920、0.883,灵敏度分别为81.7%、83.8%,特异度分别为85.9%、78.5%,均高于其他无创性评估指标.结论RDW与乙型肝炎肝硬化失代偿及并发消化道出血相关,是了解肝硬化患者病情进展严重程度的重要参考指标,在评估肝硬化患者有无出血倾向中有一定的临床价值.
