肝硬化脓毒血症的危险因素分析

摘要

Objective To investigate the risk factors of sepsis in patients with liver cirrhosis.Methods One hundred and seventy-five patients with post hepatitis HBV cirrhosis diagnosed from January 2011 to November 2016 admitted to the digestive department of No.254 Hospital of PLA,12 cases were rejeted due to incomplete data,other 163 cases were collected as the study subjects,44 cases complicated with sepsis as sepsis group,119 cases without sepsis as non-sepsis group.The risk factors of sepsis in patients with liver cirrhosis were analyzed by logistic regression using age, sex, invasive operation history in the last 2 weeks, proton pump inhibitor, platelet count, white blood cell,neutrophils,highly sensitive C reactive protein,procalcitonin,albumin,liver hardness, Child-Turcotte-Pugh,model for end stage liver disease (MELD) scores as potential risk factors.Results Univariate analysis showed that MELD scores, white blood cell,neutrophils,highly sensitive C reactive protein,invasive operation history in the last 2 weeks, proton pump inhibitor, platelet count, MELD scores were possible variables for sepsis in patients with liver cirrhosis.After multivariate analysis, highly sensitive C reactive protein and invasive operation history in the last 2 weeks were the risk factors of sepsis in cirrhotic patients.Conclusion For patients with cirrhosis, we should pay great attention to the changes of highly sensitive C reactive protein, and try to avoid invasive procedure, which are the risk factors of sepsis in patients with liver cirrhosis.%目的 探讨肝硬化患者发生脓毒血症的危险因素.方法 回顾性分析2011年1月-2016年11月解放军第254医院消化内科诊断明确的乙肝后肝硬化175例作为研究对象(剔除12例资料不全者后为163例),其中合并脓毒血症(脓毒血症组)44例,未合并脓毒血症(非毒脓血症组)119例.以性别、年龄、近2周侵袭性操作史、质子泵抑制剂应用、血小板计数(PLT)、白细胞(WBC)、中性粒细胞(N)、高敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白蛋白(Alb)、肝硬度、肝硬化CTP分级、终末期肝病模型(MELD)评分作为影响因素,采用Logistic回归分析肝硬化患者发生脓毒血症的危险因素.结果 2组近2周侵袭性操作史、WBC、N、hs-CRP比较差异有统计学意义(χ2/ t =7.125、15.436、12.212、12.234, P <0.01),而PLT、Alb、PCT比较差异无统计学意义( P >0.05).2组MELD比较差异有统计学意义( P <0.01),而肝硬度、CTP分级比较差异无统计学意义( P >0.05).经过多因素分析,高hs-CRP血症、近2周侵袭性操作史是肝硬化患者发生脓毒血症的危险因素.结论 对于肝硬化患者,应高度注意血清hs-CRP的变化、尽量避免实施侵袭性操作.