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梗阻性黄疸患者胆汁与血液标本的病原菌分析
Analysis of pathogenic bacteria in bile and blood of patients with obstructive jaundice
文章发布日期:2017年01月06日  来源:  作者:李静,吴广利,王伟,等  点击次数:1593次  下载次数:277次

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【摘要】:目的观察梗阻性黄疸患者胆汁与血液标本的病原菌分布情况。方法选取2012年1月-2016年4月滨州医学院附属医院消化内科、肝胆外科收治的梗阻性黄疸患者322例,取胆汁标本,其中84例患者同时行血培养,分析良、恶性梗阻及不同方法治疗对胆道感染患者胆汁病原菌检出率有无影响,比较胆汁及血液病原菌检出率有无差异。计数资料组间比较采用χ2检验。结果 322例梗阻性黄疸患者中检测出病原菌246例,检出率为76.40%;共检出病原菌267株,其中革兰阴性菌208株,革兰阳性菌48株,真菌11株。256例行经内镜逆行胰胆管造影(ERCP)者检出病原菌199例,检出率77.73%;66例行外科手术者检出病原菌47例,检出率71.21%,2组患者病原菌检出率比较,差异无统计学意义(χ2=1.238,P=0.266)。288例良性梗阻性黄疸患者检出病原菌215例,检出率7465%;34例恶性梗阻性黄疸患者检出病原菌31例,检出率91.18%,2组患者病原菌检出率比较,差异有统计学意义(χ2=4605,P=0.032)。良、恶性梗阻患者胆汁病原菌菌群分布比较,差异无统计学意义(χ2=0.159,P=0.690)。胆汁标本与血标本病原菌种类相似,两者病原菌检出率比较,差异有统计学意义(χ2=13.235,P<0.001)。结论梗阻性黄疸患者行ERCP或外科手术的病原菌检出率无明显差异。对部分不适宜ERCP及手术治疗的患者,可根据血培养结果指导用药。
【Abstract】:ObjectiveTo investigate the distribution of pathogenic bacteria in the bile and blood samples of patients with obstructive jaundice. MethodsA total of 322 patients with obstructive jaundice who were admitted to Department of Gastroenterology and Department of Hepatobiliary Surgery in The Affiliated Hospital of Binzhou Medical University from January 2012 to April 2016 were enrolled. Bile samples were obtained from all patients and blood culture was performed for 84 patients. The influence of benign and malignant obstruction and therapies on the detection rate of pathogenic bacteria in bile was analyzed, and the detection rate of pathogenic bacteria in bile and blood was compared. The chi-square test was used for comparison of categorical data between groups. ResultsPathogenic bacteria were detected in 246 patients (246/322), resulting in a detection rate of 76.40%. A total of 267 strains were detected, which consisted of 208 strains of Gram-negative bacteria, 48 strains of Gram-positive bacteria, and 11 strains of fungi. Among the 256 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), 199 were detected to have pathogenic bacteria, resulting in a detection rate of 77.73%; among the 66 patients who underwent surgery, 47 were detected to have pathogenic bacteria, resulting in a detection rate of 71.21%. There was no significant difference in the detection rate of pathogenic bacteria between these two groups (χ2=1.238, P=0.266). Among the 288 patients with benign obstructive jaundice, 215 were detected to have pathogenic bacteria, resulting in a detection rate of 74.65%; among the 34 patients with malignant obstructive jaundice, 31 were detected to have pathogenic bacteria, resulting in a detection rate of 91.18%. There was a significant difference in the detection rate of pathogenic bacteria between these two groups (χ2=4.605, P=0.032), and there was a significant difference in the distribution of pathogenic bacteria in bile between these two groups (χ2=0.159, P=0.690). The types of pathogenic bacteria in bile samples were similar to those in blood samples, and there was a significant difference in the detection of pathogenic bacteria between them (χ2=13.235, P<0.001). ConclusionThere is no significant difference in the detection rate of pathogenic bacteria determined by ERCP or surgery in patients with obstructive jaundice. For patients who cannot undergo ERCP or surgery, blood culture results can be used to guide clinical medication.
【关键字】:黄疸, 阻塞性; 胰胆管造影术, 内窥镜逆行; 革兰氏阴性菌; 革兰氏阳性菌
【Key words】:jaundice, obstructive; cholangiopancreatography, endoscopic retrograde; Gram-negative bacteria; Gram-positive bacteria
【引证本文】:李静, 吴广利, 王伟, 等. 梗阻性黄疸患者胆汁与血液标本的病原菌分析[J]. 临床肝胆病杂志, 2017, 33(2): 320-323.

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