摘要
目的比较研究肝衰竭合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)诊断标准的临床意义。方法选取解放军第三○二医院2003—2008年住院的肝衰竭患者1810例,从中选取合并SBP者共420例,其中腹水多形核白细胞(polymorphonuclear leucocyte,PMN)计数≥250/mm3者为143例(A组),腹水白细胞(white blood cell,WBC)计数≥250/mm3或腹水PMN比例≥25%,但不足A组标准者277例(B组)。对2组患者基本资料、抗生素治疗前后腹水WBC和PMN计数以及患者预后等进行分析。结果治疗前A组肝衰竭合并全身炎症反应综合征患者多于B组(P<0.01)。治疗5d时,A组59.7%(40/67)的患者腹水PMN计数控制在250/mm3以内;B组患者腹水WBC、PMN计数与较治疗前相比,差异无统计学意义(P均>0.05);2组间比较,A组腹水WBC、PMN计数明显高于B组(P均<0.01)。治疗10d时,A组92.3%(24/26)的患者腹水PMN计数控制在250/mm3以内;B组患者腹水WBC、PMN计数与较治疗前相比,差异仍无统计学意义(P均>0.05);2组间比较,腹水WBC、PMN计数差异无统计学意义(P均>0.05)。结论腹水PMN计数≥250/mm3作为SBP的诊断标准更为合理,更具有治疗价值。对肝衰竭合并SBP患者,建议抗感染疗程在10d以上。
Objective To compare and evaluate the clinical significance of two diagnostic criteria of spontaneous bacterial peritonitis (SBP) in patients with liver failure. Methods Totally 1 810 inpatients with liver failure in 302 hospital of PLA during 2003 -- 2008 were enrolled. Among the patients, 420 patients complicated by SBP were chosen, 143 patients with aseitic fluid polymorphonuclear leucocyte (PMN) counts greater than or equal to 250 cells/mm^3 (group A), and 277 patients with aseitic fluid white blood cell (WBC) counts greater than or equal to 250 cells/mm^3 or the proportion of ascitic fluid PMN greater than or equal to 25%, but PMN counts less than 250 cells/mm^3 (group B). Patients' clinical data, ascitic fluid WBC and PMN counts before and after antibiotic treatment, and the prognosis of both groups, etc. were compared and analyzed. Results Group A had more cirrhotic patients with systemic inflammatory reaction syndrome than group B before treatment (P〈0.01). On the 5th day of antibiotic treatment, ascitic fluid PMN counts were controlled less than 250 cells/mm^3 in 59.7%(40/67) patients of group A, and compared to pretherapy, ascitic fluid WBC and PMN counts were not significantly different in patients of group B after treatment (P 〉0.05). Aseitic fluid WBC and PMN counts in the patients of group A were markedly higher than those in the patients of group B (P〈0.01). On the lOth day of antibiotic treatment, aseitic fluid PMN counts were controlled less than 250 cells/mm^3 in 92.3%(24/26) patients of group A, and compared to pretherapy, ascitic fluid WBC and PMN counts were not significantly different in patients of group B after treatment (P 〉0.05). There were no significant differences in ascitic fluid WBC and PMN counts between the patients of both groups. Conclusions As a diagnostic criterion, ascitic fluid PMN count greater than or equal to 250 cells/mm^3 is more reasonable and significant in the diagnosis of SBP. It is suggested that long-term (more than 10 days) anti-infection treatment is a better choice for SBP patients with liver failure.
出处
《传染病信息》
2009年第5期291-293,297,共4页
Infectious Disease Information
基金
国家"十一五"科技重大专项(2008ZX10002-005-6)
关键词
原发性腹膜炎
肝衰竭
诊断标准
spontaneous bacterial peritonitis
liver failure
diagnostic criterion