肝硬化并自发性细菌性腹膜炎86例临床分析

Clinical Analysis of 86 Cases of Cirrhosis with Spontaneous Bacterial Peritonitis

目的:了解肝硬化并发自发性细菌性腹膜炎的临床特征。方法:以肝硬化及原发性肝癌并自发性细菌性腹膜炎患者为临床对象,回顾性的分析其临床症状、体征、实验室检查结果、腹水培养及药敏情况及预后等。结果:肝硬化并自发性腹膜炎的发病率为33.9%,临床表现以发热、腹痛为主要表现,而典型的腹膜刺激征,仅见于约半数的患者。外周血白细胞升高者也不多见,但绝大多数患者外周血中性粒细胞分类升高,腹水白细胞及PMN明显升高。腹水培养阳性率低,以G-杆菌为主,头孢类抗生素疗效最好。合并SBP患者死亡率明显高于无SBP患者。结论:SBP的诊断应以腹水白细胞、PMN和外周血象中性分类为主要依据,积极使用头孢类抗生素治疗,对提高疗效和改善预后有积极意义。

Objective：To investigate the clinical features of spontaneous bacterial peritonitis（SBP）in patients with cirrhosis.Methods ：The clinical manifestations and signs,the laboratory examinations,ascitic fluid cultures and drugs sensitivity test and the prognosis of SBP were retrospectively analyzed in 86 patients with cirrhosis and 35 patients with hepatocellular carcinoma.Results：The percents of SBP in patients with cirrhosis was 33.9%,fever and abdominal pain are common,about half of the patients have the typical tender abdomen.The peripheral leukocytosis was not common,most of patients with an elevated peripheral neutrophil count and ascitic fluid WBC count,the absolute polymorphonuclear leukocyte（PMN）count was elevated.The positivity of ascitic fluid culture was low,most of the flora was gram-negative bacteria,the third-generation cephalosporin was the most effective treatment.The mortality of patients with SBP was higher than that without SBP.Conclusion：Diagnosis of SBP should be based on ascitic fluid WBC count and PMN count,and peripheral neutrophil count.The cephalosporin therapy is significantly helpful for the treatment and prognosis of patients with SBP.