关键词: 肝衰竭, 乙型肝炎, 感染, 病原菌, 高迁移率族蛋白B1, 可溶性髓系细胞触发受体-1

Abstract: Objective The aim of this study was to investigate the pathogenic distribution and serum hight mobility group protein-B1 and soluble myeloid cell trigger receptor -1(sTREM-1) changes in patients with hepatitis B liver failure. Methods 179 patients with chronic hepatitis B liver failure were admitted to the Department of Infectious Diseases of our hospital between January 2017 and June 2019, and the pathogenic bacteria were separated and characterized routinely, and serum levels of HMGB1 and sICAM-1 were assayed by enzyme-linked immunosorbent assay. Results During the treatment, the infection occurred in 115 patients (64.2%) and it didn’t occurred in 64 patients, and the single site infection was 67.8%, double site infection was 27.0%,and three site infection was 5.2% with abdominal infection more common (44.9%), followed by respiratory infection (23.4%), biliary tract infection (18.4%), and sepsis (2.5%); a total of 205 pathogenic bacteria were isolated from the 115 infected patients, including 119 Gram-negative bacteria (58.0%), mainly Escherichia coli (41.5%), 55 Gram-positive bacteria (26.8%), mainly Staphylococcus aureus (12.7%), and 31 fungi (15.1%), mainly Candida albicans (8.8%); 59.1% of patients with infection had three or more complications was, significantly higher than 39.1% in the uninfected group (P<0.05), the percentage of hepatic encephalopathy was 37.4% in patients with infection, significantly higher than that in the uninfected group (18.8%, P<0.05), the percentage of hyponatremia was 59.1%, significantly higher than that in the uninfected group (26.6%, P<0.05), and the percentage of gastrointestinal hemorrhage was 13.9%, much higher than that in uninfected group (3.1%, P<0.05); serum level of creatinine was (93.7±31.7) μmol/L, significantly higher than that in the uninfected group [(81.0±26.6) μ mol/L, P<0.05], serum HMGB1 level was (13.1±2.6) ng/ml, much higher than that in the uninfected group [(10.2±2 2.0) ng/ml, P<0.05], and the MELD score was (28.2±5.0), significantly higher than that in patients without infection [(20.3±3.8), P<0.05], while serum sICAM-1 level was (804.3±134.7)ng/ml, much lower than [(1152.7±263.5)ng/ml, P<0.05]in the uninfected group. Conclusion The infection rate in patients with hepatitis B liver failure is high, the abdominal infection is more common, and the pathogenic bacterias are mainly Gram-negative bacteria. Serum HMGB1 level in patients with liver failure increase and serum sICAM-1 decrease, and these features might help clinicians to deal with appropriately in time.

Key words: Liver failure, Hepatitis B, Infection, Pathogenic bacteria, High mobility group protein-B1, Soluble myeloid cell trigger receptor-1