肝硬化自发性细菌性腹膜炎的诊断及治疗进展

Diagnosis and treatment of spontaneous bacterial peritonitis in cirrhotic patients

自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)是肝硬化腹水患者常见并发症,在诊断上,以腹水中多形核白细胞(polymorphonuclear cells,PMNs)≥250/m L及细菌培养为主要手段,腹水中白细胞酯酶同工酶、pH值、降钙素原、乳铁蛋白、粒细胞弹性蛋白酶和白细胞吞噬细菌DNA等指标测定对SBP的诊断有一定帮助.第三代头孢菌类抗生素,尤其是头孢噻肟是肝硬化SBP的主要治疗方法,而输注白蛋白能够阻止SBP患者肾功能损害及降低死亡率.

Spontaneous bacterial peritonitis（SBP） is a common complication in liver cirrhotic patients with ascites. Polymorphonuclear cells250/mL and bacterial cultures of ascitic fluid are main means for diagnosis of SBP. Leukocyte esterase isozyme, p H value, procalcitonin, lactoferrin, granulocyte elastase and phagocytized bacterial DNA in leukocytes from ascitic fluid also play a role in the diagnosis of SBP. Third-generation cephalosporins（especially cefotaxime） are the most appropriate antibiotics for the treatment of SBP. Albumin infusion can prevent renal impairment and reduce mortality among patients with SBP.