全身炎性反应综合征在乙型肝炎肝硬化合并腹水患者住院结局中的临床意义

新发传染病电子杂志 ›› 2020, Vol. 5 ›› Issue (1): 20-24.

全身炎性反应综合征在乙型肝炎肝硬化合并腹水患者住院结局中的临床意义

嵇婷婷¹, 叶伟², 赵伟²

1.东南大学医学院,南京 210009;
2.东南大学医学院附属南京市第二医院肝病科,南京 210003

出版日期:2020-01-20 发布日期:2020-04-22
通讯作者: 赵伟, Email:zhaoweiseu@126.com
基金资助:
1.江苏省青年医学人才项目（QNRC2016060）; 2.南京市医学科技发展项目（YKK17173）

Clinical significance of systemic inflammatory response syndrome in the in-hospital outcome of hepatitis B cirrhotic patients with ascites

Ji Tingting¹, Ye Wei², Zhao Wei²

1.School of Medicine,Southeast University, Nanjing 210009,China;
2.Department of Hepatology, Nanjing Second Hospital Affiliated to Southeast University School of Medicine, Nanjing 210003,China

Online:2020-01-20 Published:2020-04-22

摘要/Abstract

摘要： 目的探讨全身炎性反应综合征（SIRS）在乙型肝炎肝硬化合并腹水住院患者中的发生率及其对患者住院结局的影响。方法收集2013年1月至2018年1月东南大学医学院附属南京市第二医院住院的乙型肝炎肝硬化腹水患者的临床资料,分析SIRS的发生率及其与患者临床指标、住院期间出现死亡及门静脉高压并发症（包括食管胃底静脉曲张破裂出血、肝性脑病、肝肾综合征）的关系,分析乙型肝炎肝硬化合并腹水患者住院期间发生死亡和门静脉高压并发症的预测因素。结果乙型肝炎肝硬化合并腹水住院患者共461例,其中出现SIRS的有185例,发生率为40.1%;合并SIRS组患者与未合并SIRS组相比,存在较高的黄疸发生率、细菌感染率、血清胆红素（TBil）、国际标准化比值(INR)、Child-Pugh评分、MELD评分以及较长的住院时间,存在较低的血红蛋白浓度（Hb）、血小板（PLT）计数、钠离子浓度,差异均有统计学意义（P<0.05）。住院期间,共计22例患者死亡（5.8%）,8例发生消化道出血（1.7%）,4例发生1型肝肾综合征（0.9%）,20例发生肝性脑病（4.3%）。SIRS的发生与患者的死亡（P<0.001）及门静脉高压并发症的出现（P<0.001）均有关。MELD评分可同时预测死亡和门静脉高压相关并发症的发生（P<0.001）,而SIRS和血红蛋白可预测门静脉高压并发症的发生（P<0.05）。结论 SIRS在乙型肝炎肝硬化合并腹水住院患者中较为常见,可加重患者肝损害,导致其住院期间的病死率和门静脉高压并发症的发生率增高,SIRS的存在可预测患者门静脉高压并发症的发生。

关键词: 全身炎性反应综合征, 乙型肝炎肝硬化合并腹水, 死亡, 门静脉高压并发症

Abstract: Objective To investigate the incidence of SIRS in HBV-related cirrhotic patients with ascites and determine its relationship with in-hospital outcome. Methods A study was conducted to explore the incidence of SIRS in HBV-related cirrhotic patients with ascites admitted to the Second Hospital of Nanjing from January 2013 to January 2018 and its relationship with clinical index, death and portal hypertension-related complications (including esophagogastric varices bleeding, hepatic encephalopathy and hepatorenal syndrome) during hospitalization, to further analyze the predictors of death and portal hypertension-related complications in these patients. Results There were 461 HBV-related cirrhotic patients with ascites, of which 185 had SIRS, with an incidence rate of 40.1%. We found significant correlation between SIRS and high incidence of jaundice, bacterial infection on admission, serum bilirubin, INR, Child-Pugh score, MELD score, the duration of hospital stay and low hemoglobin concentration, platelet concentration, and sodium concentration (all P<0.05). During in-hospital follow-up, 22 patients died (5.8%), 8 developed portal hypertension-related bleeding (1.7%), 4 developed hepatorenal syndrome type-1 (0.9%), and 20 developed encephalopathy (4.3%). SIRS was demonstrated to be related both to death (P<0.001) and portal hypertension-related complications(P<0.001). MELD score was the predictor of death and portal hypertension-related complications (P<0.001), while SIRS and hemoglobin were the predictors of portal hypertension related-complications (P<0.05). Conclusion SIRS is common in HBV-related cirrhotic patients with ascites, further aggravating liver function, which leads to higher incidence of in-hospital mortality and portal hypertension-related complications. The presence of SIRS can predict portal hypertension-related complications.

Key words: Systemic inflammatory response syndrome, hepatitis B cirrhotic patients with ascites, Death, Portal hypertension-related complications

嵇婷婷, 叶伟, 赵伟. 全身炎性反应综合征在乙型肝炎肝硬化合并腹水患者住院结局中的临床意义[J]. 新发传染病电子杂志, 2020, 5(1): 20-24.

Ji Tingting, Ye Wei, Zhao Wei. Clinical significance of systemic inflammatory response syndrome in the in-hospital outcome of hepatitis B cirrhotic patients with ascites[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(1): 20-24.

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