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医学论文范文:乙型肝炎肝硬化并发自发性细菌性腹膜炎的相关因素
【摘要】 目的 研究乙型肝炎(HBV)肝硬化患者并发自发性细菌性腹膜炎（SBP)的相关危险因素。方法 调查研究济南市传染病医院568例住院乙型肝炎肝硬化患者的人口资料、血生化、HBV血清学及病毒学指标，采用SPSS 软件13.0版进行统计学分析。结果 568例患者中，228例合并SBP，单因素分析显示，SBP组患者的总胆红素（TBIL)、凝血酶原时间（PT)、甘油三酯（TG)水平与脾脏厚度均明显高于非SBP组患者，SBP组患者的丙氨酸氨基转移酶（ALT)、白蛋白（ALB)、γ谷氨酰转肽酶（GGT)、胆固醇（CH)及血小板（PLT)水平均明显低于非SBP组患者；两组患者在性别、饮酒史、HBeAg阳性、是否并发糖尿病、天门冬氨酸氨基转移酶（AST)、甲胎蛋白（AFP)、碱性磷酸酶（AKP)及门静脉直径的差异无统计学意义。调整性别、年龄、饮酒史、AKP异常、PLT异常、HBeAg、ALT＞200U/L、AST＞200U/L及门静脉直径＞1.4cm等因素后，多因素Logistic回归分析显示：TBIL＞50μmol/L、ALB＜35g/L、CH＜2.6mmol/L及脾脏厚度＞4cm是乙型肝炎肝硬化并发SBP的独立危险因素。结论 TBIL升高、ALB降低、CH降低、脾脏肿大是乙型肝炎肝硬化并发SBP的独立危险因素,肝功能低下和脾脏肿大与SBP的发生密切相关，门静脉增宽不是并发SBP的独立危险因素。
【关键词】 肝炎 乙型 肝硬化 腹膜炎
peritonitis in hepatitis B virus related liver cirrhosis
LI Qiang1, LIU Yuejin2, LI Wenwen1, YU Jinhong1, LIU Li1, YANG Xia1
(1. Second Department of Liver Diseases； 2. Department of Nosocomial Infection,
Jinan Infectious Disease Hospital, Jinan 250021, China医.学全.在.线网站www.lindalemus.com)
To investigate the factors associated with the presence of spontaneous bacterial peritonitis (SBP) in patients with hepatitis B virus(HBV)related liver cirrhosis. Methods 568 patients with HBVrelated 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 nonSBP 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 HBVrelated cirrhosis.
Key words: Hepatitis B; Liver cirrhosis; Peritonitis
自发性细菌性腹膜炎（spontaneous bacterial peritonitis, SBP)是指在腹腔及邻近组织无感染源的情况下发生的腹水感染，常见于肝硬化患者, 发病率约占住院肝硬化患者的7%～30%［1］。在我国，SBP最常见于乙型肝炎肝硬化患者，有关肝硬化并发SBP危险因素的分析国内外均有报道，但既往的研究或者样本量偏少、统计分析采用单因素的方法，或研究的因素不够全面，研究对象中混杂着各种病因的肝硬化患者，不能充分阐明乙型肝炎肝硬化并发SBP危险因素［24］。为此，本研究调查了济南市传染病医院2005年住院的乙型肝炎肝硬化患者568例，分析研究并发SBP的危险因素。
1 资料与方法
1.1 资料
