肝硬化并结核性腹膜炎与肝硬化并自发性腹膜炎患者间临床特征比较

Comparing the clinical characteristics of tuberculous peritonitis and spontaneous bacterial peritonitis in cirrhotic patients

目的:探讨肝硬化并结核性腹膜炎(tuberculous peritonitis,TBP)与肝硬化并自发性腹膜炎(spontaneous bacterial peritonitis,SBP)患者间临床特征差异。方法:收集2000年1月至2010年6月间温州医学院附属第一医院住院资料完整的肝硬化患者共102例。其中肝硬化并TBP患者28例,肝硬化并SBP患者74例。回顾性比较两组患者间年龄、性别、肝硬化病因、Child-Pugh分级、既往结核病史、实验室检查等。结果:TBP主要发生于病毒性肝硬化患者(57.1%),Child-Pugh分级主要分布在B级(75.0%),既往常有结核病史(71.4%),而SBP患者主要发生于酒精性肝硬化患者(52.7%);Child-Pugh分级主要分布在C级(77.0%);与肝硬化并SBP患者比较:肝硬化并TBP患者肝功能损害较轻,腹水白细胞计数较低,并且以淋巴细胞为主,腹水腺苷脱氨酶水平较高。余指标无差异。结论:肝硬化并TBP患者与肝硬化并SBP患者在年龄、性别分布上无差异,而导致肝硬化的病因、Child-Pugh分级、既往有无结核病史、肝功能、腹水白细胞计数及各种白细胞比例、腺苷脱氨酶可作为鉴别两者的重要参考依据。

Objective To compare the clinical characteristics of tuberculous peritonitis （TP） and spontaneous bacterial peritonitis （SBP） in cirrhotic patients. Methods We conducted a retrospective review of 102 cirrhotic patients patients seen at the first Hospital of Wenzhou Medical College from 2000 to 2010.28 patients met the diagnostic criteria TP and liver cirrhosis, and 74 patients met the diagnostic criteria SBP and liver cirrhosis. Ages, sex, cause of cirrhosis, Child-Pugh classification, history of tuberculosis and laboratory examinations were collected; and a comparative analysis was performed between the two groups. Results Compared to SBP, TP in cirrhotic patients was more frequently associated with viral cirrhosis （57.1%）, Child-Pugh classification class B at onset （75.0%） and tuberculosis history （71.4%）. Compared to TP, SBP was associated with alcoholic cirrhosis （52.7%）, Child-Pugh classification class C at onset （77.0%）. Compared to SBP, TP was associated with mild liver damage, lower white blood cell count in ascites, a higher proportion of leukocytes in ascites and higher adenosine deaminase activity in ascites. Conclusion There were no differences in age, sex distribution between TP and SBP in cirrhotic patients. TP should be suspected in cirrhotic patients with relevant clinical characteristics of ascites such as history of tuberculosis, liver function, white blood cell count and adenosine deaminase in ascites.