醫(yī)學(xué)論文范文:乙型肝炎肝硬化并發(fā)自發(fā)性細(xì)菌性腹膜炎的相關(guān)因素

醫(yī)學(xué)論文范文:乙型肝炎肝硬化并發(fā)自發(fā)性細(xì)菌性腹膜炎的相關(guān)因素

【摘要】  目的 研究乙型肝炎(HBV)肝硬化患者并發(fā)自發(fā)性細(xì)菌性腹膜炎（SBP)的相關(guān)危險(xiǎn)因素。方法 調(diào)查研究濟(jì)南市傳染病醫(yī)院568例住院乙型肝炎肝硬化患者的人口資料、血生化、HBV血清學(xué)及病毒學(xué)指標(biāo)，采用SPSS 軟件13.0版進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果 568例患者中，228例合并SBP，單因素分析顯示，SBP組患者的總膽紅素（TBIL)、凝血酶原時(shí)間（PT)、甘油三酯（TG)水平與脾臟厚度均明顯高于非SBP組患者，SBP組患者的丙氨酸氨基轉(zhuǎn)移酶（ALT)、白蛋白（ALB)、γ�补劝滨＾D(zhuǎn)肽酶（GGT)、膽固醇（CH)及血小板（PLT)水平均明顯低于非SBP組患者；兩組患者在性別、飲酒史、HBeAg陽(yáng)性、是否并發(fā)糖尿病、天門冬氨酸氨基轉(zhuǎn)移酶（AST)、甲胎蛋白（AFP)、堿性磷酸酶（AKP)及門靜脈直徑的差異無(wú)統(tǒng)計(jì)學(xué)意義。調(diào)整性別、年齡、飲酒史、AKP異常、PLT異常、HBeAg、ALT＞200U/L、AST＞200U/L及門靜脈直徑＞1.4cm等因素后，多因素Logistic回歸分析顯示：TBIL＞50μmol/L、ALB＜35g/L、CH＜2.6mmol/L及脾臟厚度＞4cm是乙型肝炎肝硬化并發(fā)SBP的獨(dú)立危險(xiǎn)因素。結(jié)論 TBIL升高、ALB降低、CH降低、脾臟腫大是乙型肝炎肝硬化并發(fā)SBP的獨(dú)立危險(xiǎn)因素,肝功能低下和脾臟腫大與SBP的發(fā)生密切相關(guān)，門靜脈增寬不是并發(fā)SBP的獨(dú)立危險(xiǎn)因素。

【關(guān)鍵詞】  肝炎 乙型 肝硬化 腹膜炎

peritonitis  in hepatitis B virus related liver cirrhosis

LI Qiang1, LIU Yue�瞛in2,   LI Wen�瞱en1,  YU Jin�瞙ong1,  LIU Li1,  YANG Xia1

(1. Second Department of Liver Diseases；   2. Department of Nosocomial Infection,

Jinan Infectious Disease Hospital, Jinan 250021, China醫(yī).學(xué)全.在.線網(wǎng)站zxtf.net.cn)

To investigate the factors associated with the presence of spontaneous bacterial peritonitis (SBP) in patients with hepatitis B virus(HBV)�瞨elated liver cirrhosis. Methods  568 patients with HBV�瞨elated liver cirrhosis hospitalized in Jinan Infectious Disease Hospital were investigated. Demographic data and biochemical parameters were analyzed by using SPSS software. Results  The prevalence rate of SBP was 40.1% in the cohort studied.　Univariate analysis showed that the TBIL, PT and TG levels, and the thickness of the spleen were higher, however, the ALT, ALB, GGT, CH and PLT levels were lower in the SBP group than those in the non�睸BP group. There were no statistical differences in gender, alcohol abuse, HBeAg, presence of diabetes,  age, AST, AFP, AKP and diameter of portal vein levels between the two groups. After adjustment of gender, age, alcohol abuse, AKP abnormal, PLT abnormal, HBeAg, ALT, AST and diameter of the portal vein, multiple regression analysis showed that TBIL＞50μmol/L, ALB＜35g/L, CH＜2.6mmol/L and splenomegaly were independent risk factors of the presence of SBP. Conclusions  Increased bilirubin, decreased albumin and cholesterol and splenomegaly are independent risk factors of the presence of SBP. Impaired liver function and splenomegaly, but not enlargement of portal vein diameter, are associated with the presence of SBP in HBV�瞨elated cirrhosis.

Key words: Hepatitis B; Liver cirrhosis; Peritonitis

自發(fā)性細(xì)菌性腹膜炎（spontaneous bacterial peritonitis, SBP)是指在腹腔及鄰近組織無(wú)感染源的情況下發(fā)生的腹水感染，常見于肝硬化患者, 發(fā)病率約占住院肝硬化患者的7%～30%［1］。在我國(guó)，SBP最常見于乙型肝炎肝硬化患者，有關(guān)肝硬化并發(fā)SBP危險(xiǎn)因素的分析國(guó)內(nèi)外均有報(bào)道，但既往的研究或者樣本量偏少、統(tǒng)計(jì)分析采用單因素的方法，或研究的因素不夠全面，研究對(duì)象中混雜著各種病因的肝硬化患者，不能充分闡明乙型肝炎肝硬化并發(fā)SBP危險(xiǎn)因素［2��4］。為此，本研究調(diào)查了濟(jì)南市傳染病醫(yī)院2005年住院的乙型肝炎肝硬化患者568例，分析研究并發(fā)SBP的危險(xiǎn)因素。

1  資料與方法

1.1  資料

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