【论文摘要】脾切除术对肝硬化患者感染风险的影响

The effect of splenectomy on the risk of infection in patients with liver cirrhosis

脾切除术对肝硬化患者感染风险的影响

Background: Splenectomy has been reported to improve liver function as well as hypersplenism, but it is still controversial whether splenectomy will further damage the immune function of patients with liver cirrhosis. This study aims to evaluate the impact of splenectomy on the risk of infection in patients with liver cirrhosis.

背景:已有文献报道脾切除术可改善肝硬化患者的肝脏功能及缓解脾功能亢进，但脾切除术是否会对其免疫功能造成进一步损害仍存在争议。本研究旨在评估脾切除术对肝硬化患者感染风险的影响。

Methods: A total of 4355 patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University from October 1, 2016 to September 30, 2020 were enrolled. The patients were first divided into the splenectomy group (SG) and the nonsplenectomy group (NSG). After standardization, patients were further divided according to the stage of cirrhosis. Infection rates in different stages were calculated, respectively. Laboratory results and infection sites of patients with cirrhosis were analyzed in combination with clinical data.

方法:收集2016年10月1日至2020年9月30日在南京医科大学第一附属医院住院治疗的肝硬化患者4355例，其中502例患者经历过脾切除手术，3853例患者未行脾切除术。进行标准化处理后，计算不同肝硬化分期患者的感染率，并结合临床资料分析肝硬化患者的实验室检查结果及感染部位差异。

Results: Bacterial infection was diagnosed in 497 of the 4355 (11.41%) hospitalizations of patients with cirrhosis. The infection rate of the compensated cirrhosis splenectomy group was higher than that of the non-splenectomy group (8.06% vs 5.18%, P<0.05). However, the infection rate in the splenectomy group with decompensated cirrhosis was lower than that in the non-splenectomy group (11.35% vs 22.23%, P<0.001). The peak level of leukocytes did not differ significantly between the splenectomy group with compensated liver cirrhosisand and the non-splenectomy group [11.97 (7.65)×109/L vs 12.19 (14.04)×109/L, P>0. 05], the peak value in splenectomy group suffering from decompensated liver cirrhosis was significantly higher than that in non-splenectomy group [12.29 (11.52)×109/L vs 6.37 (8.90)×109/L, P=0.004]. Patients with decompensated liver cirrhosis had a significantly higher rate of abdominal infection than patients with compensated liver cirrhosis, and splenectomy itself did not affect the sites of infection.

结果:4355例肝硬化患者中合并细菌性感染者497例(11.41%)。对于肝硬化代偿期的患者，脾切除组的感染率高于未切除组(8.06% vs 5.18%, P<0.05)，对于肝硬化失代偿期的患者，脾切除组的感染率低于未切除组(11.35% vs 22.23%, P<0.001)。肝硬化代偿期脾切除组患者感染时白细胞峰值和未切除组无显著差异[11.97 (7.65)×109/L vs 12.19 (14.04)×109/L, P>0. 05]，而失代偿期脾切除组患者感染时白细胞峰值显著高于未切除组[12.29 (11.52)×109/L vs 6.37 (8.90)×109/L, P=0.004]。肝硬化失代偿期患者腹腔感染的比例显著高于代偿期患者，脾切除术本身并不影响感染发生部位。

Conclusions: Splenectomy increases the risk of infection for patients with compensated liver cirrhosis, but significantly decreases the risk in patients with decompensated liver cirrhosis.

结论:对于肝硬化代偿期的患者，脾切除术会增加其未来感染的风险；而对于肝硬化失代偿期患者，脾切除术能减少远期感染的发生。

参考文献：Feng T, Hou X, Zhang W, et al. The effect of splenectomy on the risk of infection in patients with liver cirrhosis. Infect DisImmun 2022;2(1):15–20. doi: 10.1097/ID9.0000000000000035

来源：江苏省人民医院感染病科

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