Clin Transl Gastroenterol:失代偿期肝硬化合并糖尿病:自发性细菌性腹膜炎风险增加

2018-10-04 《国际肝病》编辑部 国际肝病

2型糖尿病是肝硬化患者的常见共患病,最近德国学者的一项研究发现,患有糖尿病的肝硬化患者发生自发性细菌性腹膜炎(SBP)的风险增加。

2型糖尿病是肝硬化患者的常见共患病,最近德国学者的一项研究发现,患有糖尿病的肝硬化患者发生自发性细菌性腹膜炎(SBP)的风险增加。

研究者共分析了475例肝硬化伴腹水的连续病例,平均随访266天。这些患者中25%(118例)诊断合并患有糖尿病。合并糖尿病的患者的SBP风险增加了50%(HR为1.51,P=0.03)。在合并DM且糖化血红蛋白(HbA1c)≥6.4%的患者中,SBP的发生率显著增加,达HbA1c<6.4%的患者的四倍(HR:4.21,P=0.0002)。特别值得注意的是,基线HbA1c<6.4%的肝硬化患者即使合并糖尿病,其SBP风险与不伴糖尿病的患者相似(HR:0.93,P=0.78)。剔除所有适合进行抗生素二级预防的患者后,分析显示,HbA1c≥6.4%与首次发生SBP密切相关(P=0.003)。

据此,研究者认为,如果肝硬化患者合并糖尿病,HbA1c或有助于对SBP风险进一步分层,能帮助鉴别那些从抗生素预防性治疗中获益的患者。

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href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jun 19 21:14:00 CST 2019, time=2019-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657081, encodeId=ff93165e08165, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Fri Apr 19 07:14:00 CST 2019, time=2019-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348213, encodeId=c7dc3482134c, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160304/IMG56D94856B1B5D6405.jpg, createdBy=27931687771, createdName=一个字-牛, createdTime=Sat Oct 06 15:46:51 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355463, encodeId=f5221355463d8, content=<a href='/topic/show?id=16a88565992' target=_blank style='color:#2F92EE;'>#腹膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85659, encryptionId=16a88565992, topicName=腹膜炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530577, encodeId=e55b15305e744, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1711677, encodeId=3f8d1e11677de, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Wed Jan 23 17:14:00 CST 2019, time=2019-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1985547, encodeId=ce69198554e09, content=<a href='/topic/show?id=b3d686092a2' target=_blank style='color:#2F92EE;'>#自发性细菌性腹膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86092, encryptionId=b3d686092a2, topicName=自发性细菌性腹膜炎)], attachment=null, authenticateStatus=null, 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topicId=null, topicList=[TopicDto(id=17755, encryptionId=d0841e75535, topicName=Transl)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Sat Nov 24 17:14:00 CST 2018, time=2018-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2072325, encodeId=e17620e2325a6, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Tue Jul 30 08:14:00 CST 2019, time=2019-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2064511, encodeId=ca18206451171, content=<a href='/topic/show?id=94ffe853a7' target=_blank style='color:#2F92EE;'>#Gastroenterol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7853, encryptionId=94ffe853a7, topicName=Gastroenterol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Wed Jun 19 21:14:00 CST 2019, time=2019-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1657081, encodeId=ff93165e08165, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=757b24868428, createdName=bsmagic9140, createdTime=Fri Apr 19 07:14:00 CST 2019, time=2019-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348213, encodeId=c7dc3482134c, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160304/IMG56D94856B1B5D6405.jpg, createdBy=27931687771, createdName=一个字-牛, createdTime=Sat Oct 06 15:46:51 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355463, encodeId=f5221355463d8, content=<a href='/topic/show?id=16a88565992' target=_blank style='color:#2F92EE;'>#腹膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85659, encryptionId=16a88565992, topicName=腹膜炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530577, encodeId=e55b15305e744, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=)]
    2019-07-30 许安
  6. 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  7. 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createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530577, encodeId=e55b15305e744, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=)]
    2019-04-19 bsmagic9140
  8. 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time=2019-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=348213, encodeId=c7dc3482134c, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160304/IMG56D94856B1B5D6405.jpg, createdBy=27931687771, createdName=一个字-牛, createdTime=Sat Oct 06 15:46:51 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355463, encodeId=f5221355463d8, content=<a href='/topic/show?id=16a88565992' target=_blank style='color:#2F92EE;'>#腹膜炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85659, encryptionId=16a88565992, topicName=腹膜炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530577, encodeId=e55b15305e744, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=)]
    2018-10-06 一个字-牛

    学习了谢谢分享

    0

  9. 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  10. 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createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530577, encodeId=e55b15305e744, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Sat Oct 06 01:14:00 CST 2018, time=2018-10-06, status=1, ipAttribution=)]
    2018-10-06 sodoo

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JAHA:肝硬化合并急性心肌梗死患者β受体阻滞剂的选择

由此可见,在肝硬化合并急性心肌梗死患者中,选择β受体阻滞剂是一个临床难题。该研究结果表明使用选择性β1受体阻断剂可降低主要心脏和脑血管事件的风险。

J Gastroenterol Hepatol:肝脏硬度、脾脏硬度、脾直径与血小板比评分在食管静脉曲张检测中的准确性

对于EV的检测,在可获得情况下,该研究更倾向于使用LSPS和SS而不是LS;对于检测HREV,由于LS、SS和LSPS的敏感性和特异性中等,因此本研究不推荐采用。

J Hepatol:在抗病毒治疗期间,ALT水平正常与慢性乙型肝炎患者肝脏事件的风险降低有关

接受核苷酸类似物治疗的患者,在获得正常的ALT水平后,肝脏相关事件发生的风险降低。

Hepatol Res:质子泵抑制剂治疗不会增加肝硬化患者血清内毒素水平

研究结果表明,PPI的使用并不会对肠道内毒素的血清水平产生重大影响,因为肝硬化患者的肠渗透率增加,内毒素水平已经升高了。

J Antimicrob Chemother:肝硬化儿童患者降低卡泊芬净维持剂量 好心办坏事?

2018年9月1日,发表于《J Antimicrob Chemother》上的一项临床试验表明,儿童乙型或丙型肝炎肝硬化患者不需要调整卡泊芬净的剂量。