163例慢性重型乙型病毒性肝炎合并自发性细菌性腹膜炎的临床分析

Clinical analysis of 163 chronic severe viral hepatitis B patients complicated with spontaneous bacterial peritonitis

目的探讨慢性重型乙型病毒性肝炎合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)临床特点,以提高疗效和改善预后。方法回顾性分析我科2008年1月至2010年12月住院的慢性重型乙型病毒性肝炎患者400例,合并SBP患者163例,男性137例,女性26例,年龄(44.21±11.30)岁。观察临床表现、血液检查、腹腔积液常规及细菌培养等情况,根据药敏及临床经验予抗生素治疗,观察疗效及转归因素分析。结果 163例慢性重型乙型病毒性肝炎合并SBP患者主要表现腹部压痛(75.46%)、腹胀(61.35%)、腹痛(52.15%)、反跳痛(47.24%),主要并发症为肝性脑病(30.06%)、肾功能不全(19.63%),少数表现为消化道出血、休克、发热。腹腔积液白细胞数和中性粒细胞比例升高者分别为17.79%(29/163)和16.56%(27/163);腹腔积液或血液细菌培养阳性率分别仅为2.35%或23.53%,几乎为革兰染色阴性杆菌。慢性重型乙型病毒性肝炎合并SBP的住院期间死亡率为4.29%,除外自动出院患者,其住院期间死亡率上升至15.56%,治愈率84.44%。年龄、肝性脑病、肾功能不全、总胆红素、凝血酶原时间在治愈组和无效组中存在统计学差异(P<0.05)。结论慢性重型乙型病毒性肝炎合并SBP患者的临床表现不典型,及时、经验性抗感染治疗可提高患者治愈率。

Objective To study the clinical features of chronic severe viral hepatitis B patients complicated with spontaneous bacterial peritonitis（SBP） to improve the therapeutic effect and prognosis.Methods A total of 400 inpatients with chronic severe viral hepatitis B in our department from Jan.2008 to Dec.2010 were enrolled.Retrospective data from the clinical records of 163 consecutive episodes of SBP were selected,including 137 men and 26 women with an average age of 44.21±11.30.Clinical manifestations,blood routine,ascites routine and bacterial culture of the patients were examined.The patients were treated with antibiotics based on the drug sensitivity test and clinical experience.The therapeutic effect and prognosis were further evaluated.Results The main clinical manifestations of the 163 patients comprised abdominal tenderness（75.46%）,abdominal distension（61.35%）,abdominal ache（52.15%） and rebound tenderness（47.24%）.The main complications were hepatic encephalopathy（30.06%）,and renal dysfunction（19.63%）.The uncommon clinical manifestations were gastrointestinal hemorrhage,shock and fever.The ascending rates of white blood cell count and neutrophilic granulocyte ratio in ascites were 17.79%（29/163） and 16.56%（27/163）,respectively.The positive rates of bacterial culture in ascites and in peripheral blood were 2.35% and 23.53%,respectively.Almost all the bacteria were Gram-negative bacillus.The death rate of chronic severe viral hepatitis B complicated with SBP was 4.29% during hospital.Except for automatic discharge,the death rate was up to 15.56% and the curative rate was 84.44%.Age,liver encephalopathy,abnormal renal function,total bilirubin and prothrombin time（P〈0.05） are significance in two groups.Conclusion Chronic severe viral hepatitis B patients complicated with（SBP）.Early diagnosis and timely and experiential anti-infection treatment could improve the therapeutic effect.