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慢加急性肝衰竭合并细菌感染患者抗感染治疗72小时的效果及影响因素

李晨 苏海滨 刘晓燕 许祥 李会 彭宇辉 严立龙

李欢, 孙静, 张弢, 范毓泽, 孙颖哲, 何卫平, 段学章. 射波刀治疗复发性肝癌患者的效果及预后分析[J]. 临床肝胆病杂志, 2017, 33(12): 2337-2341. DOI: 10.3969/j.issn.1001-5256.2017.12.016.
引用本文: 李欢, 孙静, 张弢, 范毓泽, 孙颖哲, 何卫平, 段学章. 射波刀治疗复发性肝癌患者的效果及预后分析[J]. 临床肝胆病杂志, 2017, 33(12): 2337-2341. DOI: 10.3969/j.issn.1001-5256.2017.12.016.
Li Huan, Sun Jing, Zhang Tao, Fan YuZe, Sun YingZhe, He WeiPing, Duan XueZhang. Effect of Cyber Knife radiosurgery on survival rate of patients with recurrent liver cancer after surgery[J]. J Clin Hepatol, 2017, 33(12): 2337-2341. DOI: 10.3969/j.issn.1001-5256.2017.12.016.
Citation: Li Huan, Sun Jing, Zhang Tao, Fan YuZe, Sun YingZhe, He WeiPing, Duan XueZhang. Effect of Cyber Knife radiosurgery on survival rate of patients with recurrent liver cancer after surgery[J]. J Clin Hepatol, 2017, 33(12): 2337-2341. DOI: 10.3969/j.issn.1001-5256.2017.12.016.

慢加急性肝衰竭合并细菌感染患者抗感染治疗72小时的效果及影响因素

DOI: 10.3969/j.issn.1001-5256.2019.01.028
详细信息
  • 中图分类号: R575.3

Clinical outcome of patients with acute-on-chronic liver failure and bacterial infection after 72 hours of anti-infective therapy

  • 摘要:

    目的探讨入院时合并细菌感染的慢加急性肝衰竭(ACLF)患者72 h抗感染疗效及影响因素。方法运用电子数据库选取解放军总医院第五医学中心2014年1月-2016年3月收治的267例入院时合并细菌感染的ACLF患者,分析患者的临床特征,根据72 h抗感染疗效将患者分为有效组(n=156)和无效组(n=111)。正态分布计量资料2组间比较采用t检验,非正态分布计量资料2组间比较使用Mann-Whitney U秩和检验。分类资料2组间比较使用χ2检验。应用logistic回归分析影响患者72 h抗感染疗效的危险因素并建立预测模型,利用受试者工作特征曲线(ROC曲线)评价模型的诊断价值。结果 HBV感染(161例)、酒精性肝病(60例)是最常见病因;共发生感染性休克29例。发生312例次细菌感染,腹水(199例)、肺部(77例)是最常见感染部位。培养菌株49株,大肠埃希菌(16株)、肺炎克雷伯杆菌(13株)是最常见菌株。合并真菌感染20例。156例(58. 4%)患者抗感染治疗有效。有效组急性肾损伤发生率、肝性脑病发生率、感染性休克发生率、肺部感染率、合并真菌感染率、WBC、中性粒细胞计数、AL...

     

  • [1] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association;Severe Liver Failure and Artificial Liver Group, Chinese Society Of Hepatology, Chinese Medical Association.Diagnostic and Treatment guidelines for liver failure (2012 version) [J].Chin J Infect Dis, 2013, 21 (3) :129-137. (in Chinese) 中华医学会感染病学会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝功能衰竭诊治指南 (2012年版) [J].中华传染病杂志, 2013, 31 (3) :129-137.
    [2]FERNNDEZ J, ACEVEDO J, WIEST R, et al.Bacterial and fungal infections in acute-on-chronic liver failure:Prevalence, characteristics and impact on prognosis[J].Gut, 2018, 67 (10) :1870-1880.
    [3]PALEVSKY PM, LIU KD, BROPHY PD, et al.KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J].Am J Kidney Dis, 2013, 61 (5) :649-672.
    [4]Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol, 2017, 33 (10) :1847-1863. (in Chinese) 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志, 2017, 33 (10) :1847-1863.
    [5]Chinese Society of Gastroenterology and Chinese Society of Hepatology, Chinese Medical Association.Consensus on the diagnosis and treatment of hepatic encephalopathy in China (Chongqing, 2013) [J/CD].Chin J Front Med Sci:Electronic version, 2014, 6 (2) :81-93. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会.中国肝性脑病诊治共识意见 (2013年, 重庆) [J/CD].中国医学前沿杂志:电子版, 2014, 6 (2) :81-93.
    [6]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :203-219. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-219.
    [7]Chinese Medical Association Critical Care Medicine Branch.Guidelines for the diagnosis and treatment of invasive fungal infections in critically ill patients (2007) [J].Chin J Intern Med, 2007, 46 (11) :960-966. (in Chinese) 中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南 (2007) [J].中华内科杂志, 2007, 46 (11) :960-966.
    [8]HUANG X, DENG ZD, NI YX, et al.Chinese experts’consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J].Chin J Infect Control, 2015, 14 (1) :1-9. (in Chinese) 黄勋, 邓子德, 倪语星, 等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志, 2015, 14 (1) :1-9.
    [9] Chinese Medical Association Critical Care Medicine Branch.Guidelines for the treatment of severe sepsis/septic shock in China (2014) [J].Chin Crit Care Med, 2015, 27 (6) :401-426. (in Chinese) 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南 (2014) [J].中华危重病急救医学, 2015, 27 (6) :401-426.
    [10]Ministry Of Health of the People’s Republic of China.Diagnostic criteria for nosocomial infections (proposed) [J].Natl Med J China, 2001, 81 (5) :314-320. (in Chinese) 中华人民共和国卫生部.医院感染诊断标准 (试行) [J].中华医学杂志, 2001, 81 (5) :314-320.
    [11]KAMATH PS, WIESNER RH, MALINCHOC M, et al.A model to predict survival in patients with end-stage liver disease[J].Hepatology, 2001, 33 (2) :464-470.
    [12] LI C, YOU SL, LIU HL, et al.The value of the baseline MELDscores, MELD-Na scores and i MELD scores in short-tern prognosis in hepatitis B virus related acute-on-chronic liver failure patients[J].Chin Crit Care Med, 2014, 26 (8) :539-543. (in Chinese) 李晨, 游绍莉, 刘鸿凌, 等.基线MELD、MELD-Na、i MELD 3种模型对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的评估价值[J].中华危重病急救医学, 2014, 26 (8) :539-543.
    [13]MOREAU R, JALAN R, GINES P, et al.Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J].Gastroenterology, 2013, 144 (7) :1426-1437.
    [14]ZANG H, LIU HL, HAO YQ, et al.Risk factors for infections in patients with acute-on-chronic liver failure and their influences on short-term outcome[J].Infect Dis Info, 2015, 28 (5) :288-292. (in Chinese) 臧红, 刘鸿凌, 郝玉清, 等.慢加急性肝衰竭并发感染的危险因素及对近期预后的影响[J].传染病信息, 2015, 28 (5) :288-292.
    [15]CAI J, ZHANG M, HAN T, et al.Characteristics of infection and its impact on short-term outcome in patients with acuteon-chronic liver failure[J].Medicine (Baltimore) , 2017, 96 (37) :e8057.
    [16]WANG YJ.Liver failure related bacterial infection and antimicrobial treatment[J].J Prac Hepatol, 2014, 17 (2) :117-120. (in Chinese) 王英杰.肝衰竭并发细菌感染与抗生素治疗[J].实用肝脏病杂志, 2014, 17 (2) :117-120.
    [17]MCKE MM, RUMYANTSEVA T, MCKE VT, et al.Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality[J].Liver Int, 2018, 38 (4) :645-653.
    [18]LI C, WANG HF, WAN MB.Expression and dynamic changes of cytokine levels in patients with HBV-related acute-onchronic liver failure[J].Infect Dis Info, 2011, 24 (3) :151-155. (in Chinese) 李晨, 王慧芬, 万谟彬.HBV相关慢加急性肝衰竭患者体内细胞因子表达及动态变化的研究[J].传染病信息, 2011, 24 (3) :151-155.
    [19]LI C, WANG HF, HU JH, et al.Expression and dynamic changes of Treg cells in peripheral blood and the levels of interleukin-6 in serum in HBV-related acute-on-chronic liver failure patients[J/CD].Chin J Clinicians:Electronic Edition, 2012, 6 (20) :6232-6237. (in Chinese) 李晨, 王慧芬, 胡瑾华, 等.乙型肝炎病毒相关慢加急性肝衰竭患者外周血调节性T细胞、血清白细胞介素-6表达及动态变化的研究[J/CD].中华临床医师杂志:电子版, 2012, 6 (20) :6232-6237.
    [20]LI C, LIU HL, ZANG H, et al.Expression of myeloid-derived suppressor cells in peripheral blood in patients with HBV-related acute-on-chronic liver failure[J].Infect Dis Info, 2013, 26 (6) :343-347, 357. (in Chinese) 李晨, 刘鸿凌, 臧红, 等.外周血髓源性抑制细胞在HBV相关慢加急性肝衰竭患者中表达的研究[J].传染病信息, 2013, 26 (6) :343-347, 357.
    [21]WASMUTH HE, KUNZ D, YAGMUR E, et al.Patients with acute on chronic liver failure display‘sepsis-like’immune paralysis[J].J Hepatol, 2005, 42 (2) :195-201.
    [22]ZHAO Y, WANG YL, ZHAO KK, et al.Distribution and resistance of pathogens isolated from hepatic failure patients with septic shock[J].Prac J Med Pharm, 2013, 30 (3) :193-195. (in Chinese) 赵怡, 王永亮, 赵克开, 等.肝衰竭并感染性休克患者的病原菌谱及耐药性分析[J].实用医药杂志, 2013, 30 (3) :193-195.
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  • 收稿日期:  2018-08-14
  • 出版日期:  2019-01-20
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