肝衰竭合并自发性细菌性腹膜炎诊断标准比较

Comparison of two diagnostic criteria of spontaneous bacterial peritonitis in patients with liver failure

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.