【摘要】：目的:通過比較乙肝肝硬化腹水患者中是否合并自發(fā)性細菌性腹膜炎(spontaneous bacterial peritonitis,SBP),以及合并SBP的患者治療前后血漿血管性假性血友病因子(von willebrand factor,v WF)水平,探索v WF在肝硬化腹水患者合并自發(fā)性細菌性腹膜炎時的診斷價值及是否可以作為潛在的治療目標。方法:1.本研究全部數(shù)據(jù)都采用從2015年7月至2016年12月于重慶醫(yī)科大學附屬第二醫(yī)院感染科的住院患者中年齡在18歲至65歲之間,臨床診斷為乙肝肝硬化的病人中,入院后48小時內(nèi)完善肝功、凝血象、血圖分析、降鈣素原,電解質(zhì)腎功并于住院期間完善腹水定位或者腹部彩超、部分病人有腹水常規(guī)及腹水培養(yǎng)等,患者知情、并簽訂同意書留置血液標本供實驗用。經(jīng)收集后共獲得204位患者信息及血液標本,作為初篩的實驗數(shù)據(jù)來源。根據(jù)影響血漿v WF的其他影響因素同時排除肝功能受損嚴重的肝衰竭患者制定以下排除標準進一步篩選:合并其他原因所致急、慢性肝病;臨床癥狀、體征及實驗室檢查提示肝功能衰竭患者;已明確或者可疑合并腹腔外感染,入我院治療前已使用抗生素抗感染治療,入我院后經(jīng)抗感染治療2周后自發(fā)性腹膜炎仍未得到有效控制患者;合并心血管系統(tǒng)疾病、糖尿病、高脂血癥、腫瘤、出凝血性疾病及近2周有抗血小板或抗凝藥物服用史。最終獲得92例病例資料,其中男性61例、女性31例�；颊咴谥�,并簽訂同意書的前提下搜集研究對象的臨床資料,其中包括年齡、性別、血清白蛋白、總膽紅素、凝血酶原時間、腹水定性及定量、腹水檢查、腹水培養(yǎng),及通過ELISA測得的血漿v WF水平。2.數(shù)據(jù)收集完畢后開始進行統(tǒng)計學分析,根據(jù)是否合并腹水、是否在腹水基礎上合并SBP進行分組:A組為乙肝肝硬化無腹水患者(不合并SBP),B組為乙肝肝硬化腹水不合并SBP患者,C組為乙肝肝硬化腹水合并SBP患者共三組。組間比較采用單因素方差分析;同時對C組病人抗感染治療前后血漿v WF水平進行比較,采用配對t檢驗。結果:1.乙肝肝硬化腹水合并SBP患者的血漿v WF水平(2741.18±651.35)明顯高于乙肝肝硬化腹水未合并SBP患者(2022.70±527.41),差異有統(tǒng)計學意義(P0.001);在均不合并SBP的情況下,乙肝肝硬化有腹水患者的血漿v WF水平(2022.70±527.41)明顯高于乙肝肝硬化患者無腹水患者(1462.41±323.62),差異具有統(tǒng)計學意義(P=0.004)。2.乙肝肝硬化合并腹水及SBP患者通過對有效抗感染治療前后血漿v WF水平比較發(fā)現(xiàn),血漿v WF水平由治療前(2741.18±651.35)降為治療后(2197.52±562.70),差異具有統(tǒng)計學意義(P0.001)。結論:乙肝肝硬化腹水患者中,合并SBP患者血漿v WF水平明顯高于無SBP患者,且合并SBP患者經(jīng)有效的抗感染治療好轉后血漿v WF水平較治療前明顯下降。血漿v WF水平對肝硬化腹水患者是否合并SBP有一定的診斷價值,可能成為潛在的治療目標。
[Abstract]:Objective: to compare the levels of plasma von Willebrand factor (von willebrand factor v WF) in patients with hepatitis B cirrhosis and ascites with spontaneous bacterial peritonitis (spontaneous bacterial peritoneal peritonitis) before and after treatment. To explore the diagnostic value of v WF in cirrhotic ascites patients with spontaneous bacterial peritonitis and whether it can be used as a potential therapeutic target. Method 1: 1. From July 2015 to December 2016, all the data were used among the patients aged between 18 and 65 years who were clinically diagnosed as hepatitis B cirrhosis in the infection Department of the second affiliated Hospital of Chongqing Medical University. Within 48 hours after admission, liver function, coagulation, blood analysis, procalcitonin, electrolytes and renal function were improved during hospitalization. Some patients had ascites routine and ascites culture. And sign the consent to keep blood samples for the experiment. A total of 204 patient information and blood samples were collected and used as the experimental data source for primary screening. According to other influencing factors affecting plasma v WF and excluding liver failure patients whose liver function is seriously impaired, the following exclusion criteria were established: acute liver disease complicated with other causes, chronic liver disease, clinical symptoms, The signs and laboratory examination indicated that the patients with liver failure had definite or suspicious extraperitoneal infection and had been treated with antibiotics before entering our hospital. The patients with spontaneous peritonitis were not effectively controlled after 2 weeks of anti-infection treatment, and had cardiovascular diseases, diabetes mellitus, hyperlipidemia, tumor, bleeding disease and antiplatelet or anticoagulant medication in the last 2 weeks. Finally, 92 cases were obtained, including 61 males and 31 females. The patients were informed and signed a consent letter to collect the clinical data of the subjects, including age, sex, serum albumin, total bilirubin, prothrombin time, ascitic fluid qualitative and quantitative analysis, ascites examination, ascites culture. And the plasma v WF level measured by Elisa. After the data collection was completed, statistical analysis was carried out, according to whether ascites were merged, Whether to combine SBP with ascites on the basis of ascites was divided into three groups: group 1: group A: hepatitis B cirrhosis without ascites (without SBP) group B: hepatitis B cirrhosis ascites not complicated with SBP group C group: hepatitis B cirrhosis ascites with SBP group. Univariate ANOVA was used to compare the plasma vWF levels before and after anti-infective therapy in group C, and paired t test was used to compare the plasma vWF levels before and after anti-infective therapy. The result is 1: 1. The plasma vWF levels in patients with hepatitis B cirrhosis ascites complicated with SBP (2741.18 鹵651.35) were significantly higher than those in patients without hepatitis B cirrhosis ascites (2022.70 鹵527.41), the difference was statistically significant (P0.001). The plasma vWF levels in patients with ascites (2022.70 鹵527.41) were significantly higher than that in patients without ascites (1462.41 鹵323.62). The difference was statistically significant (P0. 004). The plasma vWF levels in patients with hepatitis B cirrhosis complicated with ascites and SBP before and after effective anti-infective therapy were compared. It was found that the plasma vWF levels decreased from (2741.18 鹵651.35) to (2197.52 鹵562.70) before and after treatment, and the difference was statistically significant (P0.001). Conclusion: in patients with hepatitis B cirrhosis ascites, the plasma vWF level in patients with SBP is significantly higher than that in patients without SBP, and the level of vWF in patients with SBP after effective anti-infection therapy is significantly lower than that in patients without SBP. Plasma v WF level may be a potential target for the diagnosis of cirrhotic ascites with SBP.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2;R512.62;R572.2

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