Chow Kai Ming, Szeto Cheuk Chun, Wu Alan Ka Lun, Leung Chi Bon, Kwan Bonnie Ching Ha, Li Philip Kam-Tao
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Perit Dial Int. 2006 Mar-Apr;26(2):213-7.
We hypothesized that patients with hepatitis B virus infection and cirrhosis are more susceptible to peritonitis as a complication of peritoneal dialysis (PD).
A retrospective study was carried out to compare peritonitis rates between cirrhotic and non-cirrhotic patients with hepatitis B virus infection.
Between 1994 and 2004, 25 PD patients with hepatitis B cirrhosis and 36 patients with hepatitis B without cirrhosis were included for analysis. Mean follow-up duration was 52 months. Subjects with hepatitis B cirrhosis consisted of more males and had higher total body weight. No cirrhotic patients (20 of them being Child-Pugh class A, 2 class B, and 3 class C) had undergone portosystemic shunting or liver transplantation. Cirrhotic patients had slightly higher bilirubin concentration than the non-cirrhotic group (22 +/- 50 vs 9 +/- 4 micromol/L, p = 0.16). There was no difference in median peritonitis-free survival between cirrhotic and non-cirrhotic patients (40 vs 37 months, p = 0.64 by log-rank test). The average peritonitis rate was 1 episode every 19.2 patient-months in the cirrhotic group and 1 episode every 20.5 patient-months in the non-cirrhotic group. Time to first peritonitis did not differ between the two groups with respect to gram-negative organisms (p = 0.88) or gram-positive organisms (p = 0.52). Cirrhotic patients had more frequent Streptococcus species peritonitis, which accounted for 13% of all peritonitis episodes, as opposed to 2% among the non-cirrhotic patients (p = 0.01). Overall treatment response rate and outcome did not differ between patients with and patients without cirrhosis.
Peritonitis-free survival of cirrhosis patients infected by hepatitis B virus compares favorably with thatin patients without cirrhosis. The presence of liver cirrhosis does not appear to compromise PD outcome.
我们推测乙肝病毒感染合并肝硬化的患者更易发生腹膜炎，这是腹膜透析（PD）的一种并发症。
开展一项回顾性研究，比较乙肝病毒感染的肝硬化患者与非肝硬化患者的腹膜炎发生率。
1994年至2004年期间，纳入25例乙肝肝硬化腹膜透析患者和36例非肝硬化乙肝患者进行分析。平均随访时间为52个月。乙肝肝硬化患者中男性更多，总体重更高。无肝硬化患者（其中20例为Child-Pugh A级，2例为B级，3例为C级）未接受门体分流术或肝移植。肝硬化患者的胆红素浓度略高于非肝硬化组（22±50 vs 9±4微摩尔/升，p = 0.16）。肝硬化患者和非肝硬化患者的无腹膜炎生存期中位数无差异（40个月 vs 37个月，对数秩检验p = 0.64）。肝硬化组腹膜炎平均发生率为每19.2患者月1次，非肝硬化组为每20.5患者月1次。两组在革兰氏阴性菌（p = 0.88）或革兰氏阳性菌（p = 0.52）导致的首次腹膜炎发生时间上无差异。肝硬化患者的链球菌性腹膜炎更为频繁，占所有腹膜炎发作的13%，而非肝硬化患者中这一比例为2%（p = 0.01）。有肝硬化和无肝硬化患者的总体治疗反应率及结局无差异。
乙肝病毒感染的肝硬化患者的无腹膜炎生存期与非肝硬化患者相当。肝硬化的存在似乎并未影响腹膜透析的结局。
