| Objective:1.By analyzing the collected clinical data of patients with spontaneous bacterial peritonitis(SBP)in cirrhosis ascites,the related factors of SBP were discussed.In addition,a multi-parameter joint diagnosis model was established to provide clinical basis for the early diagnosis,detection and treatment of SBP.Meanwhile,the results of ascites culture were analyzed to study the etiological characteristics of SBP.2.By studying the correlation between CTP score and TCM syndrome types in patients with SBP of cirrhosis and ascite,the relationship between infection severity and liver function impairment in SBP patients and TCM syndrome types was preliminatively evaluated,and the correlation between TCM syndrome types and various indicators in CTP scoring criteria was explored.It provides reference for TCM diagnosis and treatment of SBP.Methods:1.A retrospective analysis was performed on 135 patients with cirrhosis and ascites hospitalized in the hepatobiliary ward of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to January 2021,of which 61 patients complicated with SBP,and 74 patients with cirrhosis and ascites without SBP in the same period were selected as control group.General information,clinical manifestations,etiology of cirrhosis and laboratory indicators of patients in the two groups were collected,and CTP score was calculated.General information included age and gender,and clinical manifestations included hepatic encephalopathy,upper gastrointestinal bleeding,ascites severity,abdominal tenderness,rebound pain and abdominal muscle tension.The etiology of cirrhosis includes viral hepatitis,alcoholic liver disease,autoimmune liver disease and cirrhosis of unknown cause.Laboratory indicators include routine blood,liver function,renal function,coagulation function,D-dimer,cholinesterase,PCT,CRP,routine ascites,ascites biochemical and ascites culture results.First,the above indicators were analyzed by single factor analysis,and then the preliminary screened indicators were put into the binary logistic regression model for variable screening.A multi-parameter diagnostic model was established according to the obtained data,and the differentiation and calibration degree of the corresponding model were verified.The optimal truncation value was calculated by Youden’s index.The sensitivity and specificity of the diagnostic model were determined.According to the results of ascites culture,the types and proportions of SBP pathogens were analyzed.2.Retrospectively analyzed 61 patients with cirrhosis ascites complicated with SBP who were hospitalized in the hepatobiliary ward of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to January 2021.According to the data of the four diagnoses of TCM,according to the syndrome differentiation of bulge disease,they were divided into four syndrome types:qi stagnation and dampness obstruction,dampness and heat accumulation,spleen-kidney Yang deficiency,and liver-kidney Yin deficiency.The laboratory indicators,CTP score and four TCM diagnosis data of patients during hospitalization were collected to explore the correlation between CTP score of SBP TCM syndrome type.According to CTP score,the degree of liver function injury and infection severity of SBP patients with different TCM syndrome type were preliminarily evaluated,and the relationship between TCM syndrome type and various indexes in CTP scoring standard was explored.Results:1.Univariate analysis results showed that:Abdominal signs,total protein in ascites,percentage of multinuclear cells in ascites,qualitative characterization of ascites mucin,percentage of blood neutrophils,total protein in serum,international standardized ratio,D-dimer,procalconin,cholinesterase and CTP score were correlated with the occurrence of cirrhosis ascites complicated with SBP(P<0.05).Age,sex,etiology of cirrhosis,combined upper digestive tract hemorrhage,combined hepatic encephalopathy,alanine aminotransferase,aspartate aminotransferase,serum creatinine,serum albumin,total bilirubin,ascites glucose,hemoglobin concentration,blood lymphocyte count and platelet count were not associated with the occurrence of SBP(P>0.05).The degree of abdominal signs,total protein in ascites,percentage of multinuclear cells in ascites,qualitative determination of ascites mucin,percentage of blood neutrophils,international standardized ratio,D-dimer,procalconin and CTP scores in SBP group were significantly higher than those in non-SBP group.The levels of serum total protein,serum albumin and cholinesterase in SBP group were significantly lower than those in non-SBP group.2.In terms of the etiological characteristics of ascites culture in patients with cirrhosis complicated with SBP,G~+bacteria were the main pathogenic bacteria,among which staphylococcus accounted for the highest proportion,and G~-bacteria accounted for the highest proportion of Enterobacteria.Fungal infections were also detected in SBP patients.3.Multivariate binary logistic regression analysis showed that total protein in ascites,percentage of multinucleated cells in ascites,percentage of blood neutrophils,international standardized ratio,D-dimer,and procalcitonin were correlated with the occurrence of cirrhosis ascites complicated with SBP(P<0.05),and all were positively correlated.According to the results of binary logistic regression analysis,diagnostic models were established according to whether ascites related laboratory indicators were included:Model F1=-20.616+0.230NEUT(%)+0.067PCT(ng/d L)+0.246 percentage of multinuclear cells in ascites(%)-0.126 total protein in ascites(g/L)and model F2=-11.066+0.129 without ascites index Neut(%)+0.169D-D(mg/L)+0.038PCT(ng/d L).The two diagnostic models were tested to have good discriminative degree(AUC area was much larger than 0.5)and calibration degree(P>0.05).4.A total of 61 patients with cirrhosis ascites complicated with spontaneous bacterial peritonitis were included in this study.According to the data of four TCM diagnoses,they were divided into four syndromes of qi stagnation and dampness obstruction,dampness-heat accumulation syndrome,spleen-kidney Yang deficiency syndrome,and liver-kidney Yin deficiency syndrome,among which dampness-heat accumulation syndrome was the most(34.4%),followed by liver-kidney Yin deficiency syndrome(26.2%).Male patients were more than female patients(male:female=1.3:1);Compared with the four syndromes of traditional Chinese medicine,the CTP scores of patients with spleen-kidney-yang deficiency syndrome,damp-heat accumulation syndrome and liver-kidney-yin deficiency syndrome were significantly higher than those of patients with qi stagnation and dampness block syndrome.There were also significant differences in CTP scores between patients with damp-heat accumulation syndrome and spleen-kidney-yang deficiency syndrome,as well as between patients with spleen-kidney-yang deficiency syndrome and liver-kidney-yin deficiency syndrome(P<0.05).There were significant differences in ALB(g/L),INR and TBil(mol/L)among the four TCM syndrome types in SBP patients(P<0.05),which may be related to the disease progression and severity of SBP patients.Conclusion:1.For cirrhosis patients with ascites,abdominal signs,total protein in ascites,percentage of multinucleated cells in ascites,qualitative determination of ascites mucin,percentage of blood neutrophils,total protein in serum,international standardized ratio,D-dimer,procalcitonin,cholinesterase,and CTP score were correlated with the occurrence of SBP.Two multi-parameter diagnostic models established by screening have certain value for the early diagnosis of SBP.2.The results of this study showed that G~+bacteria accounted for a higher proportion of SBP pathogenic bacteria than G~-bacteria,among which Staphylococcus and Escherichia coli were the main pathogenic bacteria.3.In SBP patients,damp-heat accumulation syndrome was the most common,followed by liver and kidney Yin deficiency syndrome.CTP scores were correlated with TCM syndrome types.Patients with mild CTP scores were mainly characterized by qi stagnation and dampness obstruction,while those with damp-heat accumulation,spleen-kidney Yang deficiency,and liver-kidney Yin deficiency were mostly moderate-severe patients.TCM syndrome types were correlated with some indexes in CTP scoring criteria,which was considered to be related to the severity of patients’condition and TCM syndrome differentiation characteristics. |
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