自发性细菌性腹膜炎与高死亡率有关,这与全国性肝硬化队列中的抗生素预防相互作用
Scott Silvey1, Nilang Patel2, Jacqueline G O'Leary3
1Department of Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Alimentary pharmacology & therapeutics
|December 21, 2025
概括
自发细菌性腹膜炎 (SBP) 增加了无补偿性肝硬化患者的死亡率,特别是在复发时. SBP预防没有影响肝移植率,但与较高的死亡率和抗生素耐药性增加有关.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 传染性疾病 传染性疾病
- 临床结果研究研究
背景情况:
- 随着人口结构和细菌学的变化,需要重新评估自发细菌性腹膜炎 (SBP) 对肝硬化结果的影响.
- 脱补偿性肝硬化带来了重大挑战,而SBP是主要的并发症.
- 了解SBP在死亡率和肝移植 (LT) 中的作用对于患者管理至关重要.
研究的目的:
- 评估SBP,其复发和预防与全国退伍军人队列中的死亡率和LT之间的关联.
- 研究SBP发作和预防策略与临床结果之间的相互作用.
- 分析与SBP及其治疗相关的抗生素耐药性的趋势.
主要方法:
- 分析了一组首次肝衰退的退伍军人 (2009-2019) 的全国队列.
- 评估包括SBP发展,初级SBP预防 (PSPr) 和二级SBP预防 (SSPr).
- 统计方法确定了SBP,预防,死亡率和LT之间的关联.
主要成果:
- 在52,392名退伍军人中,16.7%有1次SBP发作,2.3%有2次,0.8%有3次或更多.
- SBP预防与增加的死亡率有关 (PSPr:24%更高的风险;SSPr:根据复发情况增加5-28%的风险).
- 抗生素耐药性随着SBP发作和预防药物的使用而增加,但尽管有记录的耐药性,但预防药物经常继续使用.
结论:
- 在不补偿性肝硬化中,SBP显著增加了死亡率,结果在复发时恶化.
- SBP预防表明与较高的死亡率有关,但与LT率无关.
- 抗生素耐药性增加和低于最佳的预防管理突显出需要新的SBP预防策略.
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