本文選題：慢加急性肝衰竭 + 慢性乙型肝炎　； 參考：《重慶醫(yī)科大學》2013年碩士論文

【摘要】：背景 目前認為的原發(fā)性腹膜炎主要發(fā)生機制是腸道細菌的過度生長及移位。而乳果糖的應用可以明顯增強腸道沙門氏菌的移位，質(zhì)子泵抑制劑（PPI）可以通過抑制胃酸的分泌而增加消化道細菌的定植，并在綜合其它因素后使細菌移位變得更加容易。故本文旨在探索慢性乙型肝炎（CHB）基礎上的慢加急性肝衰竭（ACLF）患者中乳果糖及PPI的應用是否和原發(fā)性腹膜炎（SBP）的發(fā)生具有相關性。 方法 入選了重慶醫(yī)科大學附二院2005年1月到2010年12月期間住院的CHB基礎上的ACLF患者進行回顧性病例對照研究，符合標準的總共118例。收集分析了這些患者的人口統(tǒng)計學及臨床資料，并探索ACLF患者SBP發(fā)生的可能的危險因素。入院后發(fā)生SBP的病例組和沒有發(fā)生SBP的對照組1:1頻數(shù)匹配（59vs59）。同時也對納入病例的預后進行了分析。Logistic回歸分析用來控制混雜因素從而確定發(fā)生SBP的危險因素。 結果 在病例組中發(fā)生SBP前乳果糖的應用比率比對照組高，且差異有統(tǒng)計學意義（55.9%vs.28.8%, p=0.005），PPI的應用也有相似結果，兩組差異也具有統(tǒng)計學意義（86.4%vs.67.8%, p=0.0273）。自動出院或死亡組中住院期間SBP發(fā)生的比率是65.0%，而好轉出院組的SBP發(fā)生率為32.7%，差異有統(tǒng)計學意義（p=0.000）。病例組和對照組在性別、年齡及血漿國際標準化比率（INR）等方面沒用顯著性差異，，同樣的，在發(fā)生SBP之前兩組在乙型肝炎脫氧核糖核酸（HBV-DNA）、丙氨酸氨基轉移酶（ALT）、天門冬氨酸氨基轉移酶（AST）、白蛋白（ALB）及發(fā)生SBP前有無腹水等方面也沒有顯著性差異（P0.05）。在多因素Logistic回歸分析中，ACLF患者中SBP的發(fā)生和PPI的應用是相關的（OR,2.564；95%CI,0.989-6.648; p=0.047），乳果糖的應用也和ACLF患者SBP的發(fā)生明顯相關（OR,2.818;95%CI,1.294-6.136; p=0.008）。和已有的結論一樣，SBP的發(fā)生和ACLF患者的預后密切相關（OR,0.257；95%CI,0.105-0.631; p=0.003）。這些ACLF患者中，預防性或治療應用PPI的有78%的患者沒有明確的使用PPI的指針。 結論 CHB基礎上的ACLF患者中，乳果糖及PPI應用和SBP的發(fā)生呈明顯正相關。病程中SBP的發(fā)生也和自動出院或死亡不良結局也呈明顯正相關。因此，合理地應用乳果糖或PPI顯得十分重要，除了對已經(jīng)發(fā)生的SBP要積極抗感染治療外，盡早盡量減少SBP發(fā)生的風險也十分關鍵。仍需要前瞻性的雙盲的隨機對照研究進一步證明是否盡量避免應用乳果糖及PPI可以減少ACLF患者SBP的發(fā)生率，從而改善患者預后。
[Abstract]:Background the main mechanism of primary peritonitis is the overgrowth and translocation of intestinal bacteria. Proton pump inhibitor (PPI) can increase bacterial colonization of digestive tract by inhibiting gastric acid secretion, and make bacterial translocation easier after combining other factors. The purpose of this study was to explore whether the use of lactulose and PPI in patients with chronic hepatitis B (CHB) and acute hepatic failure (ACLF) is related to the occurrence of primary peritonitis (SBP). Methods A retrospective case-control study of patients with ACLF on the basis of CHB from January 2005 to December 2010 in the second affiliated Hospital of Chongqing Medical University was carried out. A total of 118 patients met the criteria. The demographic and clinical data of these patients were collected and analyzed, and the possible risk factors of SBP in patients with ACLF were explored. The 1:1 frequency matching (59vs59) was found in the patients with SBP after admission and in the control group without SBP. Logistic regression analysis was used to control the confounding factors to determine the risk factors of SBP. Results the application rate of pre-SBP fructose in the case group was higher than that in the control group, and the difference was statistically significant (55.9vs.28.8B, p0.005) the application of PPI was similar, and the difference between the two groups was statistically significant (86.4vs.67.8, p0.0273). The incidence rate of SBP during hospitalization was 65.0 in the group of automatic discharge or death, while the incidence of SBP in the group of improved discharge was 32.70.The difference was statistically significant (p0.000). There was no significant difference in sex, age and plasma international standardized ratio (INR) between the case group and the control group. There was no significant difference between the two groups in hepatitis B deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (alt), aspartate aminotransferase (AST), albumin (ALB) and ascites before SBP (P0.05). In multivariate logistic regression analysis, the occurrence of SBP and the use of PPI in ACLF patients were correlated (OR2. 564 / 95CII 0.989-6.648; p0. 047). The use of lactulose was also significantly correlated with the occurrence of SBP in patients with ACLF (OR2.81895CI1.294-6.136; p0.008). The occurrence of SBP was closely related to the prognosis of patients with ACLF (Orr 0.257 ~ 95CII 0.105-0.631; p0.003). Of these ACLF patients, 78% did not have a definite PPI pointer for prophylactic or therapeutic use of PPI. Conclusion in patients with ACLF based on CHB, the use of lactulose and PPI is positively correlated with the occurrence of SBP. The occurrence of SBP was also positively correlated with the adverse outcome of discharge or death. Therefore, it is very important to use lactilose or PPI rationally. Besides the active anti-infection treatment of SBP, it is also very important to reduce the risk of SBP as early as possible. A prospective double-blind randomized controlled study was still needed to further demonstrate whether avoiding the use of lactulose and PPI could reduce the incidence of SBP in patients with ACLF and thus improve the prognosis of patients with ACLF.
【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】：2013
【分類號】：R575.3;R572.2

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相關期刊論文 前1條

1 ;肝衰竭診療指南[J];中華肝臟病雜志;2006年09期

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