Prognostic Analysis Of Spontaneous Bacterial Peritonitis In Cirrhosis And Research On TCM Syndromes And Related Indicators

Objective:1 Through the analysis of the general clinical data,relevant laboratory detection indicators,imaging features and survival time of patients with cirrhosis who developed spontaneous bacterial peritonitis,To investigate the prognostic factors of patients with cirrhosis and spontaneous bacterial peritonitis at 1 year,and to establish risk index models through relevant influencing factors.2 To analyze the distribution characteristics of TCM syndrome types in patients with cirrhosis who developed spontaneous bacterial peritonitis,and to explore the relationship between TCM syndrome types and related indicators,and to provide certain reference for TCM physicians in clinical treatment.Methods:1 To collect 320 patients with cirrhosis complicated with spontaneous bacterial peritonitis from January 2013 to December 2016 in Beijing Ditan Hospital,Capital Medical University,and record the clinical information of patients,including age,sex,etiology of liver cirrhosis.Whether to incorporate diabetes mellitus,hypertension,PPI medication,probiotics medication history,laboratory tests(ALT,AST,ALB,TBIL,CR,NA,WBC,NE,LY,PLT,neutrophil/lymphocyte,PT,PTA,INR,PCT,CRP),imaging examinations(abdominal ultrasound,gastroscopy,abdominal CT,and abdominal MRI),ascites culture,and ascitic PMN.The study endpoint was death,and the deadline was December 31,2017.Through analysis of the clinical-related data of the survival group and the death group,a meaningful clinical index was selected for multi-factor COX regression analysis,a risk index model was established,and independent risk factors were stratified by the kaplan-meier method.2 A total of 62 patients with cirrhosis complicated with spontaneous bacterial peritonitis were collected from the Center of Integrative Medicine of Beijing Ditan Hospital,Capital Medical University.Record each patient's age,gender,etiology of liver cirrhosis,clinical manifestations,and tongue and veins,whether it is associated with diabetes,hypertension,laboratory tests(ALT,AST,ALB,TBIL,CR,NA,WBC,NE,LY,PLT,N/L,PT,PTA,INR,PCT,CRP),imaging(abdominal ultrasound,gastroscopy,abdominal CT,and abdominal MR),ascites culture,and ascites PMN,according to four types of diagnosis(including wetness)Internal resistance syndrome,damp heat internal syndrome,liver-kidney yin deficiency syndrome,and spleen-kidney yang deficiency syndrome).Compare the relationship between various syndromes of traditional Chinese medicine and related laboratory indicators.Results:1 A total of 320 patients with cirrhosis and spontaneous bacterial peritonitis were included,246 patients in the survival group and 74 in the death group,and the patient mortality rate was 23.10%.According to the general analysis of the survival group and the death group,there was no statistically significant difference in gender,whether or not diabetes,PPI use,drinking history,and whether or not hepatic encephalopathy,gastrointestinal bleeding,and hepatorenal syndrome occurred in both groups;There was a statistically significant difference in the etiology of cirrhosis and hypertensive groups,and the difference in survival time between the two groups was statistically significant.2 The laboratory results of the two groups of patients showed that:ALB,NA,TBIL and PTA levels,the difference between the two groups was statistically significant.The death group had lower ALB levels,lower NA levels,and higher TBIL than the survival group.Level and PT extension.Diagnostic paracentesis was performed in 181 patients:there was no significant difference in ascites albumin and PMN count between the two groups,and the positive rate in ascites culture was lower.There was no significant difference between the two groups.3 The imaging results of the two groups showed that there was no statistically significant difference in portal vein width and spleen thickness between the survival group and the death group;among the patients included,the degree of ascites was mainly severe,and the ascites was severe in the survival group and the death group.The patients accounted for 52.80%and 58.10%,respectively,and the difference was not statistically significant between the two groups.The severity of esophageal varices was mainly severe,with 57.60%and 65.70%of the patients in the survival group and the death group,respectively.There was no significant difference between the two groups;the Child-pugh grading was mainly in the Child-C grade.Predominance,and death group Child-pugh and MELD scores were significantly higher than the survival group.4 Multivariate COX regression analysis was performed on the factors affecting the 1-year prognosis of SBP patients.Age,history of hypertension,ALB,NA,and MELD scores were independent risk factors affecting 1-year prognosis.And establish a risk index(PI)model,PI = 0.036 × age-0.067 × ALB-0.073 × NA+0.053 X MELD+ 0.818 ×history of hypertension(is 1,if 0).The greater the PI,the higher the risk of death of the patient,with a Cut-off value of 0.353.By stratified analysis of age,ALB,serum sodium NA,and MELD scores by Kaplan-Meier analysis,the results showed that when age>56 years,ALB ? 28g/L,NA ? 135mmol/L,and the MELD scor,e>10 points,SBP patients occurred.The risk of death is high and the difference is significant.5 Analysis of syndromes and related indicators of traditional Chinese medicine showed that there was a statistically significant difference between hydrated internal resistance syndrome and damp heat internal syndrome(P<0.05).The mean value of damp heat syndrome was>liver and kidney.Yin deficiency syndrome>spleen-kidney yang deficiency syndrome>water-dampness internal resistance syndrome;ALB level,water-dampness internal resistance syndrome and other groups had statistically significant differences(P<0.05),ALB mean wet-water internal resistance>Damp-heat syndrome>Spleen-kidney yang deficiency syndrome>Liver-kidney yin deficiency syndrome;TBIL level,there was a statistically significant difference between wet-water internal resistance syndrome and damp-heat internal syndrome(P<0.05).Intrinsic syndrome>Liver-Kidney yin-deficiency syndrome>Spleen-kidney yang deficiency syndrome>Water-dampness internal resistance syndrome;CR levels,damp-heat internal syndrome and spleen-kidney yang syndrome have statistically significant differences(P<0.05),mean Damp-heat syndrome>liver-kidney yin deficiency syndrome>water-wet internal resistance syndrome>spleen-kidney yang deficiency syndrome;WBC level,there is a statistically significant difference between wet-water internal resistance syndrome and damp-heat internal syndrome(P<0.05).Mean moist heat syndrome>Spleen-kidney yang deficiency syndrome>Liver-kidney yin deficiency syndrome>Water-wet internal resistance syndrome;PT,PTA levels,water-damp internal resistance syndrome and liver-kidney yin deficiency The difference was statistically significant(P<0.05).Mean liver and kidney yin deficiency syndrome>spleen and kidney yang deficiency syndrome>damp heat syndrome>water dampness internal resistance syndrome;There was a statistically significant difference between the syndromes(P<0.05),mean liver and kidney yin deficiency syndrome,damp heat syndrome,spleen and kidney yang deficiency syndrome,and water wetness internal resistance syndrome.Conclusion:1 After univariate analysis,the risk factors for death in SBP patients include age,history of hypertension,low ALB levels,low NA levels,high TBIL levels,prolonged PT,elevated INR,and elevated Child and MELD scores.By multivariate COX regression analysis,the independent risk factors affecting 1-year prognosis of SBP patients included age,history of hypertension,ALB,NA,and MELD scores.A risk index(PI)model was established.PI=0.036×age-0.067×ALB-0.073 × NA+ 0.053 × MELD + 0.818 × history of hypertension(is 1,if 0).By stratified analysis of age,ALB,NA,and MELD scores by Kaplan-Meier analysis,the results showed that when age>56 years,ALB ? 28g/L,NA ? 135mmol/L,MELD score>10 points,SBP patients died.The risk is high and the difference is significant.2 This study included a total of 62 patients with cirrhosis and spontaneous bacterial peritonitis,and they were classified into four types by TCM syndrome differentiation.They were water-damp internal resistance syndrome,damp-heat internal syndrome,liver-kidney yin deficiency syndrome,and spleen and kidney respectively.Yang deficiency.Among them,there are many hot and humid intrinsic syndromes.Through the comparison of various types of TCM syndromes and related laboratory indicators,it is found that there is a certain correlation between TCM syndrome types and related indicators.