肝细胞癌患者自发性细菌性腹膜炎的预后。

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients.

机构信息

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

出版信息

J Korean Med Sci. 2018 Dec 7;33(52):e335. doi: 10.3346/jkms.2018.33.e335. eCollection 2018 Dec 24.

DOI:10.3346/jkms.2018.33.e335

PMID:30584413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6300660/

Abstract

BACKGROUND

Spontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients.

METHODS

This study enrolled patients diagnosed with SBP between 2005 and 2017. Medical records of patients were reviewed and clinical course was compared between the non-HCC and HCC groups.

RESULTS

In total, 123 SBP cases including 49 HCC cases were enrolled. Men were predominant (48/74, 64.9% vs. 34/49, 69.4%; = 0.697); median age was 58 years in both non-HCC and HCC groups ( = 0.887). The most common etiology was alcohol (32/74, 43.2%) in non-HCC group and hepatitis B (30/49, 61.2%) in HCC group ( = 0.009). Antibiotic resistance rate was higher in non-HCC than in HCC group (29.7% vs. 12.2%; = 0.028); in-hospital mortality did not differ between the groups (25/74, 33.8% vs. 13/49, 26.5%; = 0.431). Development rate of hepatorenal syndrome did not differ between non-HCC and HCC group (14/74, 18.9% vs. 10/49, 20.4%; = 1.000), but hepatic encephalopathy was less common in HCC group (26/74, 35.2% vs. 9/49, 18.3%; = 0.008). The most important predictor of in-hospital mortality in patients with HCC was white blood cell count above 11,570 cells/mm (odds ratio, 6.629; 95% confidence interval, 1.652-26.590; = 0.008).

CONCLUSION

Prognosis of SBP in HCC patients is relatively less severe. This result may be related with reduced antibiotics resistance and lower development rates of other complications, such as hepatic encephalopathy. Degree of systemic inflammation may be the most important factor for in-hospital mortality.

摘要

背景

自发性细菌性腹膜炎（SBP）是肝硬化患者的一种严重感染并发症。然而，关于肝癌（HCC）患者 SBP 预后的信息有限。我们研究了 HCC 患者 SBP 的临床病程。

方法

本研究纳入了 2005 年至 2017 年间诊断为 SBP 的患者。回顾患者病历并比较非 HCC 组和 HCC 组之间的临床病程。

结果

共纳入 123 例 SBP 病例，其中 49 例为 HCC 病例。男性为主（48/74，64.9% vs. 34/49，69.4%；=0.697）；非 HCC 组和 HCC 组的中位年龄均为 58 岁（=0.887）。非 HCC 组最常见的病因是酒精（32/74，43.2%），HCC 组最常见的病因是乙型肝炎（30/49，61.2%）（=0.009）。非 HCC 组的抗生素耐药率高于 HCC 组（29.7% vs. 12.2%；=0.028）；两组的住院死亡率无差异（25/74，33.8% vs. 13/49，26.5%；=0.431）。非 HCC 组和 HCC 组肝肾综合征的发生率无差异（14/74，18.9% vs. 10/49，20.4%；=1.000），但 HCC 组肝性脑病发生率较低（26/74，35.2% vs. 9/49，18.3%；=0.008）。HCC 患者住院死亡率的最重要预测因素是白细胞计数高于 11570 个/mm³（比值比，6.629；95%置信区间，1.652-26.590；=0.008）。