摘要
目的 为明确肝硬化患者合并感染的特点及危险因素。方法采用病例对照的研究方法，回顾性分析了286例肝硬化患者的感染发生情况及危险因素。结果127例患者继发了感染，感染发生率为44．4％；其中100例（78％）感染发生在医院内，感染患者的死亡率为20．5％，显著高于非感染患者的3．1％（P=0．08）；最常见的感染为自发性腹膜炎，共56例（30．7％），其次为肺部感染和胆道感染（15．7％）；标本培养97例，62例获阳性结果；其中革兰阴性菌35例（56．4％），是常见的致病菌；但在败血症中，革兰阳性菌为主要致病菌；应用多因素Logistic回归分析合并感染的危险因素，结果表明，血清白蛋白水平和住院时间是两个独立的危险因素；升高白蛋白水平及缩短住院时间可降低感染的风险，其OR值分别为0．33（95％CI 0．32～055）、0．23（95％CI 0．14～0．38）。结论血清白蛋白水平和住院时间是肝硬化患者合并感染的两个独立的危险因素。
OBJECTIVE To identify the risk factors for infections in patients with cirrhosis. METHODS A casecontrol study was employed. A total of 286 patients hospitalized between 1999 and 2003 were included in. Patients who developed infection complication were defined as case, the remains were as control. The data of possible risk factors, including serum levels of albumin （Alb）, prothrombin time （PT）, total bilirubin （T-BiD, Child-Pugh score, ascite, esophageal variceal bleeding, total cholesterol （T-chol）, other complication, the total white blood cell （wbc）, surgery, and days of hospitalization, were retrospectively collected. According to multivariate Logistic regression model, the potential risk factors were assessed. RESULTS Infections developed in 127 （44.4%） patients and 100 （78%） of those developed infection during hospitalization. The mortality rate of case was 20.5%, which was significant higher than that of control （3.1%, P=0.08）. Fifty five patients （30. 7%） had spontaneous bacterial peritonitis （sbp）. Bacterial culture of samples were prepared from 97 of 127 patients （76.4M）, and was positive in 62 （63.9%） patients. From these culture-positive samples, 35 （56.4%） samples were Gram-negative bacterial strains, 8 of 15 samples from patients developed sepsis were Gram-positive bacteria. On multivariate analysis, the Alb level and days of hospitalization were the independent risk factors for cirrhosis patients with infection complication. The odds ratio was 0.33 （95% CI 0.32-0. 55）, and 0. 23 （95M CI 0.14- 0.38）, respectively. CONCLUSIONS Patients with advanced cirrhosis with low Alb level and long days of hospitalization should be carefully treated, and administration of broad spectrum antibiotic covering Gram-positive bacteria needs to be considered in treatment of sepsis.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2006年第1期36-37,46,共3页
Chinese Journal of Nosocomiology
关键词
肝硬化
感染
危险因素
Cirrhosis
Infection
Risk factors
