108例结核性腹膜炎临床特点及检查指标分析

Analysis of clinical characteristics and examination index of 108 cases of tuberculosis peritonitis

目的分析结核性腹膜炎(TBP)的临床特点,探讨其诊疗过程。方法选取2010年8月—2013年10月天津市海河医院确诊的TBP患者为研究对象,对其临床表现、实验室、影像学等情况进行回顾性分析。结果共计108例TBP患者,多伴有其他脏器结核,以肺结核为主,占22.22%(24/108);男女比例为1∶1.7;平均年龄为(36.49±18.76)岁。临床以发热、腹痛、腹胀为主,分别占75%、70.4%和67.6%;腹部有柔韧感者占51%。T细胞斑点试验(T-SPOT)检查阳性率为66.67%,血清结合抗体和结核菌素试验(TB-Ab和PPD)检查阳性率分别为33.33%和36.84%,差异有统计学意义(P<0.05);腹水腺苷脱氨酶(ADA)阳性率为72.72%,高于腹水PCR检查阳性率(23.53%),差异有统计学意义(P<0.05);腹部CT以大网膜及腹膜增厚80%(48/60)为主要表现。正规的抗结核治疗,血沉和癌抗原125(CA125)指标会有明显的下降。结论腹部CT对识别大网膜及腹膜增厚有意义;腹腔镜获得组织病理诊断TBP最可靠,血沉及CA125可作为治疗疗效评价指标。

[ Objective ] To analyze the clinical characteristics of tuberculosis peritonitis （TBP） and explore the diagnosis and treatment process. [ Methods ]108 cases with TBP diagnosed in Tianin Haihe Hospital from August 2010 to October 2013 were collected as study object,and their clinical manifestations, laboratory and imaging conditions were analyzed retrospectively. [ Results ] Many cases accompanied with other organs tuberculosis, pulmonary tuberculosis was the main, accounted for 22.2% （24/108）; the male to female ratio was 1：1.7, the average age was （36.49＋18.76） years old . Clinical symptoms of fever, abdominal pain and abdominal distension accounted for 75%, 70.4% and 67.6%, respectively; the people with the abdomen had the feeling of flexible accounted for 51%. The positive rate of T-SPOT was 66.67%, and the positive rates of TB-Ab and PPD were 33.33% and 36.84%, the difference was statistically significant （P〈0.05）. The positive rate of adenosine deaminase （ADA） was 72.72%, which was higher than that of PCR （23.53%）, the difference was statistically significant （P〈0.05）. Greater omentum and peritoneal thickening were the main feature of abdominal CT （80%, 48/60）. After regular anti-TB treatment, the index of erythrocyte sedimentation rate （ESR） and cancer antigen 125 （CA 125） had a significant reduction.[ Conclusion ] Abdominal CT is useful for identifying greater omentum and peritoneal thickening; laparoseopy with pathological diagnosis is reliable for diagnosing TBP; ESR and CA125 can be used as evaluation index for treatment efficacy.