乙型肝炎肝硬化腹水并自发性细菌性腹膜炎52例临床分析

Clinical analysis of 52 cases of hepatitis B virus related liver cirrhosis with spontaneous bacterial peritonitis

目的了解乙型肝炎肝硬化并发自发性细菌性腹膜炎(SBP)的临床特征。方法回顾性分析52例乙型肝炎肝硬化腹水并发SBP患者的临床特征,实验室检查结果,腹水培养、药敏情况及预后等。结果肝硬化并自发性腹膜炎的发病率30.95%,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,大肠杆菌和其他革兰阴性杆菌为主要致病菌,药物敏感试验对第3代头孢菌素药物敏感。合并SBP患者死亡率明显高于无SBP患者。结论乙型肝炎肝硬化合并SBP临床表现大多数不典型,PMN计数是诊断SBP的重要指标,头孢菌素类抗生素是乙型肝炎肝硬化并发SBP患者的首选抗生素。

Objective To investigate the clinical characteristics of hepatitis B virus related liver cirrhosis with spontaneous bacterial peritonitis （SBP）. Methods The clinical characteristics,laboratory test results,ascitic culture results,drugs sensitivity test and prognosis of 52 patients with hepatitis B virus related liver cirrhosis with SBP were analyzed retrospectively. Results The incidence of SBP in liver cirrhosis was 30.95 ~. Main clinical manifestations were fever and abdominal pain,and about half of the patients had the typical peritoneal irritation. The patients with elevated peripheral white blood cells （WBC） were a few,and the patients with elevated neutrophils in peripheral blood,WBC and polymorphonuclear leucocyte （PMN） in ascites were most. Positive rate of ascitic culture was low. E. coil and other Gram negative bacilli were main pathogens, and third-generation cephalosporin was sensitive in drug susceptibility assay. Mortality in the patients with SBP was significantly higher than that in the patients without SI3P. Conclusion The clinical manifestations of hepatitis B virus related liver cirrhosis with SBP is atypical. PMN count is an important indicator of SBP diagnosis. Cephalosporins is the preferred antibiotics in the treatment hepatitis B virus related liver cirrhosis with SBP.