| 胡洪鹏,朱朝庚,戴 金,李文斌,向兴华.胆道梗阻合并胆道感染的病原学特征和危险因素及与肝脏损伤的关系研究[J].,2020,(2):303-307 |
| 胆道梗阻合并胆道感染的病原学特征和危险因素及与肝脏损伤的关系研究 |
| Etiological Characteristics and Risk Factors of Biliary Obstruction Complicated with Biliary Tract Infection and Its Relationship with Liver Injury |
| 投稿时间：2019-06-20 修订日期：2019-07-15 |
| DOI：10.13241/j.cnki.pmb.2020.02.021 |
| 中文关键词: 胆道梗阻 胆道感染 病原学特征 危险因素 肝脏损伤 |
| 英文关键词: Biliary obstruction Biliary tract infection Etiological characteristics Risk factors Liver injury |
| 基金项目:湖南省卫生计生委科研计划项目（B20160694） |
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| 中文摘要: |
| 摘要 目的：探讨胆道梗阻合并胆道感染的病原学特征和危险因素，并分析胆道感染与肝脏损伤的关系。方法：回顾性分析250例胆道梗阻患者的临床资料，分析胆道梗阻合并胆道感染的病原菌分布和主要病原菌的耐药性，分析胆道梗阻合并胆道感染的危险因素，比较各组的肝功能指标[天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、谷氨酰转移酶（GGT）、直接胆红素（DBIL）]和肝纤维化指标[层黏蛋白（LN）、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原(Ⅳ-C)]。结果：250例胆道梗阻中共有132例合并胆道感染，感染率为52.80%，共分离出病原菌150株，以革兰阴性菌和革兰阳性菌为主。粪肠球菌对红霉素的耐药率最高，屎肠球菌对林可霉素的耐药率最高，均对万古霉素的耐药率最低；大肠埃希菌和肺炎克雷伯菌均对氨苄西林的耐药率最高，对妥布霉素的耐药率最低。年龄≥60岁、有胆道手术史、肝功能Child-Pugh评分≥11分是胆道梗阻合并胆道感染的危险因素（P<0.05）。胆道感染组的AST、ALT、GGT、DBIL、LN、HA、PCⅢ、Ⅳ-C水平高于无胆道感染组和对照组，且无胆道感染组高于对照组（P<0.05）。结论：胆道梗阻患者胆道感染的发生率较高，并且胆道感染会进一步加重胆道梗阻患者的肝脏损伤，临床应根据其病原学特征和危险因素做好相应的防治工作。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the etiological characteristics and risk factors of biliary obstruction complicated with biliary tract infection, and to analyze relationship between biliary tract infection and liver injury. Methods: The clinical data of 250 patients with biliary obstruction were analyzed retrospectively. The pathogen distribution of biliary obstruction complicated with biliary tract infection and the drug resistance of main pathogens were analyzed, and the risk factors of biliary obstruction combined with biliary tract infection were analyzed. The liver function indicators of each group [aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamyltransferase (GGT), direct bilirubin (DBIL)] and liver fibrosis indicators [layered mucin (LN), hyaluronic acid (HA), type Ⅲ procollagen (PCⅢ), type Ⅳ collagen (Ⅳ-C)] were compared among the groups. Results: In 250 cases of biliary obstruction, 132 cases were complicated with biliary tract infection, the infection rate was 52.80%. A total of 150 strains of pathogenic bacteria were isolated, mainly Gram-negative bacteria and Gram-positive bacteria. Streptococcus faecalis had the highest resistance to erythromycin, Enterococcus faecium had the highest resistance to lincomycin, and the lowest resistance to vancomycin. Escherichia coli and Klebsiella pneumoniae had the highest resistance to ampicillin, and the lowest resistance to tobramycin. Age≥60 years old, history of biliary surgery and Child-Pugh score≥11 scores) of liver function were risk factors for biliary obstruction complicated with biliary infection (P<0.05). The levels of AST, ALT, GGT, DBIL, LN, HA, PCⅢ and Ⅳ-C in the biliary tract infection group were higher than those in the non-biliary tract infection group and the control group, and those in non-biliary tract infection group were higher than those in control group (P<0.05). Conclusion: The incidence of biliary obstruction complicated with biliary tract infection is high, and biliary tract infection will further aggravate liver damage in patients with biliary obstruction. The clinical prevention and treatment should be done according to its pathogenic characteristics and risk factors. |
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