乙型肝炎肝衰竭并发感染患者病原菌分布及血清HMGB1和sICAM-1水平变化

目的调查乙型肝炎肝衰竭患者并发感染的病原菌分布特点及血清高迁移率族蛋白B1(HMGB1)和可溶性髓系细胞触发受体-1(sTREM-1)水平变化。方法2015年1月~2019年6月我院感染病科诊治的179例乙型肝炎肝衰竭患者,常规培养分离病原菌,采用ELISA法检测血清HMGB1和sICAM-1水平。结果在治疗3月内,本组患者发生感染115例(64.2%),未感染64例,其中单部位感染占67.8%,双部位感染占27.0%,三部位感染占5.2%。115例并发感染患者共有感染部位158个,其中腹部感染占61.7%,呼吸系统感染占32.2%,胆道感染占25.2%,败血症占3.5%;在115例感染患者中,培养分离出病原菌205株,其中革兰阴性菌119株(58.0%),以大肠埃希菌为主(41.5%),革兰阳性菌55株(26.8%),以金黄色葡萄球菌为主(12.7%),真菌31株(15.1%),以白色念珠菌为主(8.8%);感染患者腹水发生率为73.9%,显著高于未感染组(29.7%,P<0.05),肝性脑病发生率为37.4%,显著高于未感染组(18.8%,P<0.05),低钠血症发生率为59.1%,显著高于未感染组(26.6%,P<0.05),消化道出血发生率为13.9%,显著高于未感染组(3.1%,P<0.05);感染组血清肌酐水平为(93.7±31.7)μmol/L,显著高于未感染组【(81.0±26.6)μmol/L,P<0.05】,HMGB1水平为(13.1±2.6)ng/ml,显著高于未感染组【(10.2±2.0)ng/ml,P<0.05】,MELD评分为(28.2±5.0)分,显著高于未感染组【(20.3±3.8)分,P<0.05】,而血清sICAM-1水平为(804.3±134.7)ng/ml,显著低于未感染组【(1152.7±263.5)ng/ml,P<0.05】。结论乙型肝炎肝衰竭患者感染发生率较高,感染部位以腹部最多,病原菌以革兰阴性菌为主,并发感染的乙型肝炎肝衰竭患者并发症发生率较高,血清HMGB1水平升高,sICAM-1水平降低,了解这些指标的变化规律可能有助于临床判断感染的存在。

Pathogendistribution and serum HMGB1 and sICAM-1 changes in patients with hepatitis B liver failure

Objective The aim of this study was to investigate the pathogenic distribution and serum hight mobility group protein-B1 and soluble myeloid cell trigger receptor -1(sTREM-1) changes in patients with hepatitis B liver failure. Methods 179 patients with chronic hepatitis B liver failure were admitted to the Department of Infectious Diseases of our hospital between January 2017 and June 2019, and the pathogenic bacteria were separated and characterized routinely, and serum levels of HMGB1 and sICAM-1 were assayed by enzyme-linked immunosorbent assay. Results During the treatment, the infection occurred in 115 patients (64.2%) and it didn’t occurred in 64 patients, and the single site infection was 67.8%, double site infection was 27.0%,and three site infection was 5.2% with abdominal infection more common (44.9%), followed by respiratory infection (23.4%), biliary tract infection (18.4%), and sepsis (2.5%); a total of 205 pathogenic bacteria were isolated from the 115 infected patients, including 119 Gram-negative bacteria (58.0%), mainly Escherichia coli (41.5%), 55 Gram-positive bacteria (26.8%), mainly Staphylococcus aureus (12.7%), and 31 fungi (15.1%), mainly Candida albicans (8.8%); 59.1% of patients with infection had three or more complications was, significantly higher than 39.1% in the uninfected group (P<0.05), the percentage of hepatic encephalopathy was 37.4% in patients with infection, significantly higher than that in the uninfected group (18.8%, P<0.05), the percentage of hyponatremia was 59.1%, significantly higher than that in the uninfected group (26.6%, P<0.05), and the percentage of gastrointestinal hemorrhage was 13.9%, much higher than that in uninfected group (3.1%, P<0.05); serum level of creatinine was (93.7±31.7) μmol/L, significantly higher than that in the uninfected group (81.0±26.6) μ mol/L, P<0.05], serum HMGB1 level was (13.1±2.6) ng/ml, much higher than that in the uninfected group (10.2±2 2.0) ng/ml, P<0.05], and the MELD score was (28.2±5.0), significantly higher than that in patients without infection (20.3±3.8), P<0.05], while serum sICAM-1 level was (804.3±134.7)ng/ml, much lower than (1152.7±263.5)ng/ml, P<0.05]in the uninfected group. Conclusion The infection rate in patients with hepatitis B liver failure is high, the abdominal infection is more common, and the pathogenic bacterias are mainly Gram-negative bacteria. Serum HMGB1 level in patients with liver failure increase and serum sICAM-1 decrease, and these features might help clinicians to deal with appropriately in time.