本文選題：自發(fā)性細(xì)菌性腹膜炎 + 肝硬化　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:比較醫(yī)院獲得性和醫(yī)療相關(guān)性自發(fā)性細(xì)菌性腹膜炎的臨床異同點(diǎn)及病原學(xué)現(xiàn)況,并明確影響非社區(qū)獲得性自發(fā)性細(xì)菌性腹膜炎短期生存的預(yù)測因素,為臨床治療提供幫助。材料和方法:收集2014年1月-2016年6月我院感染科收治的首次發(fā)生自發(fā)性細(xì)菌性腹膜炎且腹水培養(yǎng)陽性的肝硬化患者的臨床資料,在排除社區(qū)獲得性自發(fā)性細(xì)菌性腹膜炎后,共納入42例患者。結(jié)果:在19例醫(yī)院獲得性自發(fā)性細(xì)菌性腹膜炎(NA-SBP)和23例醫(yī)療相關(guān)性自發(fā)性細(xì)菌性腹膜炎(HCA-SBP)患者的對比中,HCA-SBP組白細(xì)胞計(jì)數(shù)顯著大于NA-SBP組(10.6±1.9 VS6.0±0.7,p0.001),同時(shí)HCA-SBP組腹水多形核白細(xì)胞(PMN)計(jì)數(shù)也明顯大于 NA-SBP 組(2938.6±1000.9VS664.9±359.0,p=0.013)。兩組其余基線值及住院后出現(xiàn)的并發(fā)癥等方面對比均無明顯差異。在對相關(guān)因素進(jìn)行校對后,兩組患者28天死亡率無明顯差異(p=0.274,0.429[0.094-1.959])。病原學(xué)現(xiàn)況對比中,NA-SBP組以革蘭陽性菌為主(63.2%),HCA-SBP組以革蘭陰性菌為主(52.2%),兩組對第三代頭孢菌素和氟喹諾酮類抗生素均有較高的耐藥性,分別為 36.8%VS 21.7%(p=0.281)和 42.1%VS 26.1%(p=0.273)。NA-SBP 組和 HCA-SBP組均有較高的腸球菌感染率,分別為21.1%和17.4%(p=1.000)。在所有患者中只有1例對碳青霉烯類藥物耐藥,其他均為敏感菌。在單因素生存分析中發(fā)現(xiàn),白細(xì)胞10*10^9/L、MELD評分20分、MELD-Na評分25分、合并肝癌、并發(fā)急性腎損傷和肝性腦病(3-4級)都與非社區(qū)獲得性SBP28天內(nèi)死亡明顯相關(guān)。在多因素分析中,急性腎損傷與非社區(qū)獲得性SBP28天死亡明顯相關(guān)(p=0.037,56.088[1.272-2474.005])。結(jié)論:在首次發(fā)生非社區(qū)獲得性SBP的肝硬化患者中,不同的病原菌來源與短期死亡無關(guān)(NA-SBPVSHCA-SBP),且兩組的基本臨床特征相似。在非社區(qū)獲得性SBP中,對第三代頭孢菌素和氟喹諾酮類藥物都有較高的耐藥性,但對碳青霉烯類的耐藥性很低。第三代頭孢菌素對非社區(qū)獲得性SBP的經(jīng)驗(yàn)性治療可能并不充分。此外住院過程中出現(xiàn)急性腎損傷是預(yù)測非社區(qū)獲得性SBP28天死亡的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to compare the clinical similarities and differences between hospital-acquired and medically related spontaneous bacterial peritonitis and its etiological status, and to determine the predictors of short-term survival of non-community-acquired spontaneous bacterial peritonitis. To provide assistance for clinical treatment. Materials and methods: the clinical data of patients with spontaneous bacterial peritonitis and positive ascites culture were collected from January 2014 to June 2016 in the infectious department of our hospital to exclude community-acquired spontaneous bacterial peritonitis. A total of 42 patients were included. Results: in 19 patients with nosocomial spontaneous bacterial peritonitis (NA-SBP) and 23 patients with medically associated spontaneous bacterial peritonitis (HCA-SBP), the white blood cell count in HCA-SBP group was significantly higher than that in NA-SBP group (10.6 鹵1.9 VS6.0 鹵0.7p 0.001g), and that in HCA-SBP group was significantly higher than that in HCA-SBP group. The number of PMNs in NA-SBP group was significantly higher than that in NA-SBP group (2938.6 鹵359.0 鹵359.0 1000.9VS664.9 鹵0.013). There were no significant differences in baseline values and complications after hospitalization between the two groups. After proofreading the related factors, there was no significant difference in the 28 day mortality between the two groups (P = 0.274), 0.429 [0.094-1.959]. The main pathogens in NA-SBP group were Gram-positive bacteria (63.2B) and HCA-SBP (52.2%). Both groups had high resistance to the third generation cephalosporins and fluoroquinolones. The infection rates of Enterococcus in 42.1%VS 26.1%(p=0.273).NA-SBP group and HCA-SBP group were higher than those in 42.1%VS 26.1%(p=0.273).NA-SBP group (21.1%) and HCA-SBP group (17.4%). Only one patient was resistant to carbapenem in all patients, and the others were sensitive bacteria. In univariate survival analysis, leukocyte 10 ^ 9 / L meld score 20% and MELD-Na score 25%, liver cancer complicated with acute renal injury and hepatic encephalopathy (grade 3-4) were significantly correlated with non-community-acquired SBP28 death within days. In multivariate analysis, there was a significant correlation between acute renal injury and mortality on non-community-acquired SBP28 days (0.037%) 56.088 [1.272-2474.005]. Conclusion: in patients with liver cirrhosis with non-community-acquired SBP for the first time, the origin of different pathogens is not related to short-term death, and the basic clinical characteristics of the two groups are similar. In non-community-acquired SBP, the third generation cephalosporins and fluoroquinolones have high resistance, but the resistance to carbapenems is very low. The third generation cephalosporins may not be sufficient in the empirical treatment of non-community-acquired SBP. In addition, acute renal injury during hospitalization is an independent risk factor for non-community-acquired SBP28 death.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R572.2
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本文編號：1838319