肝硬化自发性细菌性腹膜炎的诊断及治疗进展

Itopride hydrochloride combined with Bifidobacterium triple viable capsules for treatment of abdominal distention in chronic hepatitis B patients with liver cirrhosis

AIM

To evaluate the efficacy of itopride hydrochloride in combination with Bifidobacterium triple viable capsules in the treatment of abdominal distention in chronic hepatitis B patients with liver cirrhosis.

METHODS

Eighty-four chronic hepatitis B patients with liver cirrhosis and abdominal distention treated at the Third Hospital Affiliated to Zhejiang University of Chinese Medicine were randomly divided into a control group (n = 42) and an observation group (n = 42). Both groups were given symptomatic treatments including a low-salt diet, liver-protecting agents, diuresis, and nutritional support, and the observation group was additionally given itopride hydrochloride in combination with Bifidobacterium triple viable capsules. Clinical efficacy, symptom score, and ghrelin levels were compared between the two groups.

RESULTS

Scores of abdominal distension at 2, 4, and 8 wk after treatment were statistically lower in the observation group than in the control group (P < 0.05). Indexes of liver function after treatment, including alanine transaminase, aspartate transaminase and total bilirubin, were statistically lower than those before treatment in both groups (P < 0.05), and these indexes after treatment were significantly lower in the observation group than in the control group (P < 0.01). Endotoxin, plasma calcitonin, diamine oxidase, interleukin-1β, and tumor necrosis factor-α levels were statistically improved in both groups (P < 0.05), and these indexes after treatment were significantly better in the observation group than in the control group (P < 0.01).

CONCLUSION

Itopride hydrochloride combined with Bifidobacterium triple viable capsules can improve abdominal distention, reduce liver function indexes, and strengthen intestinal mucosal barrier function in chronic hepatitis B patients with liver cirrhosis.

Diagnostic value of serum PCT and CRP for spontaneous bacterial peritonitis in patients with liver cirrhosis

AIM: To assess the value of serum procalcitonin (PCT) and C-reactive protein (CRP) for ascites spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis and ascites.

METHODS: The clinical data for 168 patients with liver cirrhosis and ascites treated at our hospital from January 2011 to January 2016 were retrospectively analyzed. According to the presence of SBP or not, the patients were divided into two groups: SBP group and non-SBP group. Factors that can predict the development of SBP were evaluated. The receiver operating characteristic (ROC) curves for significant parameters were generated to assess their sensitivities and specificities for diagnosis of SBP.

RESULTS: Serum ALT, AST and white cell count did not differ significantly between the SBP group and non-SBP group (P > 0.05). Serum PCT and CRP in the SBP group were significantly higher than those in the non-SBP group (P < 0.05). The ROC curve analysis showed that the areas under the ROC curves of PCT and CRP were 0.951 and 0.868, respectively. Using the cut-off values of 1.9 ng/mL and 22.6 mg/L, the sensitivities were 89.1% and 86.3%, and specificities were 81.7% and 80.6%, respectively.

CONCLUSION: Abnormally elevated serum PCT and CRP are of significant value for predicting SBP in patients with liver cirrhosis and ascites.

Risk factors for spontaneous bacterial peritonitis in cirrhotic patients: A meta-analysis

AIM: To systematically identify the risk factors for spontaneous bacterial peritonitis (SBP) in cirrhotic patients.

METHODS: PubMed, Web of Science, OVID, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM) and Wanfang databases were searched to retrieve studies evaluating the risk factors for SBP in cirrhotic patients. The quality of the included papers was evaluated according to the Newcastle-Ottawa Scale (NOS) score. Meta-analysis was performed using RevMan 5.3 software.

RESULTS: A total of 31 studies were included, involving 2125 cases in the case group and 5755 cases in the control group. The results showed that SBP history (OR = 6.70, 4.68-9.59), gastrointestinal hemorrhage (OR = 3.39, 2.38-4.84), constipation (OR = 3.97, 2.58-6.11), Child-Pugh classification C (OR = 3.51, 2.56-4.81), low level of serum albumin (WMD = -3.47, -4.76--2.17), high level of serum total bilirubin (WMD = 19.06, 12.56-25.56), low level of total ascites protein (≤10 g/L) (OR = 6.63, 5.62-7.63) and prolonged prothrombin time (PT) (WMD = 2.01, 1.22-2.8) were risk factors for SBP in cirrhotic patients. Child-Pugh classification A (OR = 0.21, 0.11-0.41) and high level of total ascites protein (>10 g/L) (OR = 0.15, 0.12-0.19) were protective factors for SBP in cirrhotic patients. Age, gender, posthepatitic cirrhosis, hepatic encephalopathy, Child-Pugh classification B and diabetes had no significant association with SBP in cirrhotic patients.

CONCLUSION: SBP in cirrhotic patients is closely associated with multiple risk factors, and attention should be paid to these factors and corresponding preventive measures should be taken to reduce the incidence of SBP and prolong the survival of cirrhotic patients.