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The clinical features and prognosis of sepsis-associated cholestasis in patients with liver cirrhosis
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摘要:
目的加强对肝硬化患者并发感染相关性胆汁淤积症的认识,分析肝硬化患者并发感染相关性胆汁淤积症的临床特点、危险因素及转归。方法回顾性分析肝硬化患者并发感染相关性胆汁淤积症的临床资料,分析其临床特征及其预后,比较54例肝硬化患者并发感染相关性胆汁淤积症与同期住院的发生感染但未出现胆汁淤积症（对照组）126例肝硬化患者在年龄、性别、Child-Pugh分级、早期及时经验性抗菌药物应用的差异。结果 54例肝硬化患者并发感染相关性胆汁淤积症的感染部位:腹腔感染（自发性细菌性腹膜炎,SBP）20例、尿路感染18例、胆道感染6例、肠道感染4例、肺部感染4例、部位不明确2例,根据Child-Pugh分级约有55.56%的患者为Child C级。两组比较,年龄、Child-Pugh分级、早期及时经验性应用抗菌药物等,差异均有统计学意义（P<0.05）;观察组中病死率15.00%,高于对照组的4.36%,差异有统计学意义（P<0.05）。结论肝硬化患者并发感染相关性胆汁淤积症对预后有不良影响,尤其合并有肝肾综合征者病死率较高,应高度重视临床及实验诊断,针对其临床特征实施相应措施。
Abstract:Objective To explore the clinical features and prognosis of cirrhotic patients with concomitant sepsis-associated cholestasis.Methods A retrospective analysis of 180 patients with liver cirrhosis was performed.The clinical data, including infection, age, sex, Child-Pugh classification and antibiotic treatment, were compared between the patients with sepsis-associated cholestasis and those without using the Chi-squared test.Results Sepsis-associated cholestasis occurred in 30% (n=54) of the liver cirrhosis patients.The sepsis-related infections included spontaneous bacterial peritonitis (n=20) , urinary tract infection (n=18) , biliary tract infection (n=6) , intestinal infection (n=4) , pulmonary infection (n=4) , and undetermined infection (n=2) .The sepsis-associated cholestasis group showed significantly older age, higher Child-Pugh score, and increased antibiotics (all, P<0.05) .The mortality rate was significantly higher in the sepsis-associated cholestasis group (16/54 vs.13/126 in the non-septic cholestasis group, P<0.05) .Conclusion Sepsis-associated cholestasis in patients with advanced cirrhosis is associated with a poor prognosis.
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Key words:
- cholestasis /
- liver cirrhosis /
- bacterial infections
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[1]中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329. [2]Fuchs M, Sanval AJ.Sepsis and cholestasis[J].Clin Liver Dis, 2008, 12 (1) :151-172. [3]Fan HB, Chen AS, Yan FM, et al.Clinical analysis of 35 cases ofSepsis-associated cholestasis[J].Chin J Gastroenterol Hepatol, 2010, 19 (4) :367-368. (in Chinese) 樊和斌, 陈安慎, 严福明, 等.感染相关性胆汁淤积症35例临床分析[J].胃肠病学和肝病学杂志, 2010, 19 (4) :367-368. [4]Khalil S, Shah D, Faridi MM, et al.Prevalence and outcome ofhepatobiliary dysfunction in neonatal septicaemia[J].J PediatrGastroenterol Nutr, 2012, 54 (2) :218-222. [5]Watanakunakorn C, Chan SJ, Demarco DG, et al.Staphylococcusaureus bacteremia:significance of hyperbilirubinemia[J].Scand JInfect Dis, 1987, 19 (2) :195-203. [6]Famularo G, De Simone C, Nicotra GC.Jaundice and the sepsis syn-drome:a neglected link[J].Eue J Intern Med, 2003, 14 (4) :269-271. [7]Schuppan D, Afdhal NH.Liver cirrhosis[J].Lancet, 2008, 371 (9615) :838-851. [8]Kalambokis GN, Tsianos EV.Rifaximin reduces endotoxemia andimproves liver function and disease severity in patients with decom-pensated cirrhosis[J].Hepatology, 2012, 55 (2) :655-656. [9]Benjamin J, Singla V, Arora I, et al.Intestinal permeability andcomplications in liver cirrhosis:A prospective cohort study[J].Hepatol Res, 2012, may 25. [10]Lu LG.Mechanism of bile secretion excretion, regulaation and cho-lestasis[J].J Clin Hepatol, 2011, 27 (6) :570-580 (in Chi-nese) .陆伦根.胆汁的分泌、排泄和调节及胆汁淤积发生机制[J].临床肝胆病杂志, 2011, 27 (6) :570-580. [11]Zhang GX, Sun Y, Sun N, et al.Protective effect of erythropoieti-non lipopolysaccharide induced liver injury in rats[J].J Jilin Vniv (Med Ed) , 2012, 38 (3) :456-460. (in Chinese) 张国兴, 孙宇, 孙霓, 等.促红细胞生成素对脂多糖所致大鼠肝脏损伤的保护作用[J].吉林大学学报:医学版, 2012, 38 (3) :456-460. [12]Gentilini P, La Villa G.Liver-kidney pathophysiological interrela-tionships in liver diseases[J].Dig Liver Dis, 2008, 40 (12) :909-919. -
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