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目的 分析乙型肝炎慢加急性肝功能衰竭(acute-on-chronic liver failure,ACLF)患者合并感染的特点及其对疾病转归的影响,并探讨合并感染的相关因素.方法 对2007年1-12月中山大学附属第三医院收治的186例ACLF患者进行回顾性调查,分析感染常见部位、临床和病原学特点及其对预后的影响.采用非条件Logistic回归方法分析感染相关因素.结果 在186例ACLF患者中,合并感染160例(86.0%),常见感染部位为腹腔、胆道、肺部和肠道.血清白蛋白(Alb)≤30 g/L、总胆红素(TBil)>342 μmol/L、凝血酶原时间(PT)>28 s以及存在其他肝功能衰竭(肝衰竭)等严重并发症者有更高的感染率(χ~2值分别为5.4、7.3、21.3和14.7,P值均<0.05).ACLF合并感染者的病死率为74.5%(119/160),未合并感染者的病死率为42.3%(11/26),差异具有统计学意(χ~2=10.9,P=0.000);合并多部位感染者的病死率(79.8%,79/99)明显高于单部位感染者(65.6%,40/61),差异同样具有统计学意义(χ~2=4.0,P=0.045).结论 ACLF患者感染发生率高,且与病情的严重程度密切相关.

Objective To investigate the characteristics of secondary infections in hepatitis B patients with acute-on-chronic liver failure(ACLF)and its impact on the prognosis. Methods Infection sites, clinical and etiological characteristics were retrospectively reviewed in 186 hospitalized patients with ACLF from the Third Affiliated Hospital of Sun Yat-sen University during January to December 2007. Logistic regression was used to analyze risk factors of secondary infections. Results In 186 patients with ACLF, 160 patients(86.0%) were complicated with infections, and the common sites of infections were abdominal cavity, biliary tract, lung and intestinal tract. The rates of secondary infections were higher in patients with serum albumin(Alb)≤30 g/L, total bilirubin(TBil)>342 μmol/L, prothrombin time(PT)>28 seconds, and those complicated with one or more complications(χ~2=5.4, 7.3, 21.3 and 14.7, P<0.05). The fatality rates of patients with and without infections were 74. 5%(119/160) and 42.3%(11/26), respectively, and the difference was of statistical significance(χ~2=10.9,P=0.000). Patients with multi-organ infections had a higher fatality rate(79.8%, 79/99)than those with one organ infections(65.6%, 40/61), and the difference was also significant(χ~2=4.0, P=0.045). Conclusion Patients with ACLF are liable to infection, and the severity is closely related with the prognosis.