乙型肝炎肝硬化患者自发性细菌性腹膜炎病原菌分布特点及影响腹水消退的因素分析*

doi:10.3969/j.issn.1672-5069.2026.03.013

摘要/Abstract

摘要： 目的分析总结乙型肝炎肝硬化患者并发自发性细菌性腹膜炎(SBP)病原菌分布特点、耐药性情况及影响腹水消退的因素。方法 2020年3月～2023年12月我院诊治的乙型肝炎肝硬化并发SBP患者62例,常规培养分离和鉴定腹水细菌,给予抗感染和基础治疗,采用Logistic回归分析影响腹水消退的因素。结果在62例患者中,培养分离出病原菌77株,包括革兰氏阳性菌27株(肺炎链球菌11株、表皮葡萄球菌9株、粪肠球菌7株)和革兰氏阴性菌50株(大肠埃希菌27株、铜绿假单胞菌14株、肺炎克雷伯菌7株、阴沟肠杆菌2株);表皮葡萄球菌和粪肠球菌对头孢噻肟的耐药率分别为55.6%和100.0%,而铜绿假单胞菌和肺炎克雷伯杆菌对头孢曲松的耐药率分别为100.0%和71.4%;在治疗后随访6个月,腹水消退37例(59.7%),腹水未消退25例(40.3%);腹水未消退组合并糖尿病占比、白蛋白-胆红素评分(ALBI)、Child-Pugh评分、腹水多形核白蛋白计数和血清降钙素原水平分别为28.0%、(-1.1±0.5)、(11.4±2.9)、(502.5±162.3)×10⁶/L和(4.2±0.4)ng/ml,均显著高于腹水消退组【分别为5.4%、(-1.5±0.5)、(8.0±2.4)、(282.9±53.7)×10⁶/L和(0.7±0.3)ng/ml,P<0.05】;Logistic回归分析显示合并糖尿病、ALBI评分、Child-Pugh评分和腹水多形核白细胞计数均是影响腹水消退的独立危险因素(P<0.05)。结论了解影响乙型肝炎肝硬化并发SBP患者腹水消退的原因,做好防治医疗管理或可改善预后。

关键词: 肝硬化, 自发性细菌性腹膜炎, 病原菌, 治疗, 影响因素

Abstract: Objective The purpose of this study was to analyze pathogen distribution and factors impacting subsidence of ascites in patients with hepatitis B-induced liver cirrhosis (LC) complicated with spontaneous bacterial peritonitis (SBP). Methods 62 patients with hepatitis B-induced LC complicated by SBP were encountered in our hospital between March 2020 and December 2023, ascites pathogens were routinely separated and characterized, and all patients were carefully managed with antibiotics at base of supporting treatment. Multivariate Logistic regression analysis was applied to identify risk factors impacting subsidence of ascites. Results Of the 62 patients with SBP, 77 pathogenic strains were isolated, including 27 Gram-positive bacteria, e.g., Streptococcus pneumonia in 11, Staphylococcus epidermidis in 9, and Enterococcus faecium in 7, and 50 Gram-negative bacteria, e.g., Escherichia coli in 27, Pseudomonas aeruginosa in 14, Klebsiella pneumonia in 7, and Enterobacter cloacae in 2; the resistance of Staphylococcus epidermidis and Enterococcus faecium to cefotaxime reached to 55.6% and 100.0%, and that of Pseudomonas aeruginosa and Klebsiella pneumonia to ceftriaxone reached to 100.0% and 71.4%, respectively; by end of six-month follow-up, ascites subsided in 37 cases(59.7%), and didn’t in 25 cases (40.3%); percentage of concomitant diabetes, albumin-bilirubin scores (ALBI), Child-Pugh score, ascites polymorphonuclear cell (PMN) count and serum procalcitonin (PCT) level in patients without ascites subsidence were 28.0%, (-1.1±0.5), (11.4±2.9), (502.5±162.3)×10⁶/L and (4.2±0.4)ng/ml, all significantly higher than [5.4%, (-1.5±0.5), (8.0±2.4), (282.9±53.7)×10⁶/L and (0.7±0.3)ng/ml, respectively, P<0.05] in those with ascites subsided; multivariate Logistic regression analysis showed that concomitant diabetes, ALBI, Child-Pugh score and ascites PMN counts were all the independent risk factors impacting ascites subsidence(P<0.05). Conclusion Gram-negative bacteria are the predominant microbes in patients with hepatitis B-induced LC and complicated SBP. Effective prevention and treatment for SBP should be based on precise microbiological identification and individualized strategies.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, Pathogens, Therapy, Impacting factors

应学敏, 徐小国, 司进枚, 陈民, 卢利霞. 乙型肝炎肝硬化患者自发性细菌性腹膜炎病原菌分布特点及影响腹水消退的因素分析^*[J]. 实用肝脏病杂志, 2026, 29(3): 369-372.

Ying Xuemin, Xu Xiaoguo, Si Jinmei, et al. Pathogen distribution and factors impacting subsidence of ascites in patients with hepatitis B-induced liver cirrhosis complicated with spontaneous bacterial peritonitis[J]. Journal of Practical Hepatology, 2026, 29(3): 369-372.

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乙型肝炎肝硬化患者自发性细菌性腹膜炎病原菌分布特点及影响腹水消退的因素分析^*

Pathogen distribution and factors impacting subsidence of ascites in patients with hepatitis B-induced liver cirrhosis complicated with spontaneous bacterial peritonitis

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