腹水多形核细胞数量与自发性腹膜炎预后关系的研究

Study on the relationship between ascites polymorphonuclear cell count and prognosis of spontaneous bacterial peritonitis

目的评价腹水多形核细胞(PMN)数量与自发性腹膜炎(SBP)的预后关系。方法连续收集近2年间收治的291例SBP患者的临床资料。排除继发性、结核性腹膜炎,恶性腹水,并剔除未行腹穿或穿刺失败者40例,纳入研究的患者251例。以腹水PMN计数是否>250×106/L分为两组。比较两组间的一般情况、实验室检查、临床症状体征、合并症、治疗效果和生存率。结果在251例SBP患者中,PMN>250×106/L者63例(25%),PMN<250×106/L者188例(75%)。腹水细菌培养阳性的9例患者中,PMN>250×106/L者占77.8%(7/9),PMN<250×106/L者占22.2%(2/9)。两组患者在SBP主要症状体征方面无明显差别,均表现为有不同程度的发热、腹痛、腹胀,腹部张力增高,程度不等的压痛、反跳痛。抗菌药物治疗总有效率为67.3%(169/251),其中,PMN<250×106/L组抗菌药物治疗有效率为70.7%(133/188),PMN>250×106/L组为57.1%(36/63),两组比较差异有统计学意义(P<0.05)。在合并症方面,与PMN<250×106/L组比较,PMN>250×106/L组合并消化道出血、MODS、感染性休克较高(P均<0.05),其住院病死率及其1年内病死率均较高,差异均有统计学意义(P<0.05)。结论以PMN>250×106/L作为SBP的诊断标准,在SBP患者预后评估中具有重要意义。与PMN<250×106/L的SBP患者比较,PMN>250×106/L的SBP患者抗菌药物治疗有效率低,合并症较高,预后较差。

Objective To evaluate the relationship between ascites polymorphonuclear cell(PMN)count and prognosis of spontane-ous bacterial peritonitis(SBP). Methods We collected the clinical data of 291 cases of patients with SBP ever treated in recent 2 years in our hospital,and cases of secondary or tuberculous bacterial peritonitis,malignant ascites were excluded,together with 40 cases without ab-dominal paracentesis or with paracentesis failure. Statistical analysis was made based on the clinical data from the rest 251 patients,which were divided into two groups according to whether or not their PMN count to be higher than 250 × 106 / L. Then,the general conditions,labo-ratory examinations,clinical symptoms and signs,complications,therapeutic effect and survival rate between the two groups were compared. Results In 251 cases of SBP patients,the PMN count of 63 cases were higher than 250 × 106 / L(25% ),and 188 cases were lower than 250 × 106 / L(75% ). Ascites bacterial culture in 9 cases was positive,in which cases with PMN count ﹥ 250 × 106 / L accounted for 77. 8%(7 / 9)and PMN count ﹤ 250 × 106 / L accounted for 22. 2%(2 / 9). Further analysis revealed that the most common symptoms and signs of SBP,which manifested as fever,abdominal pain,abdominal distension,increased abdominal tension,tenderness and rebound tenderness, had no significant difference between the two groups. The total effective rate of antibiotic therapy was 67. 3%(169 / 251),andthe effective rate of cases with PMN count ﹤ 250 × 106 / L and cases with PMN count ﹥ 250 × 106 / L were 70. 7%(133 / 188),57. 1%(36 / 63),with significant difference between them(P ﹤ 0. 05). When compared with PMN count ﹤ 250 × 106 / L cases,the incidence of complications such as gastrointestinal bleeding,MODS,septic shock,in cases with PMN count ﹥ 250 × 106 / L was higher(P ﹤ 0. 05),and the hospital mortali-ty rate and the mortality rate within 1 year were also higher(P ﹤ 0. 05). Conclusion It has important significance in evaluating the progno-sis of SBP patients to define PMN count ﹥ 250 × 106 / L as diagnosis criteria of SBP. The SBP patients with PMN count ﹥ 250 × 106 / L had lower effective rate of antibiotic therapy,higher complication incidence and poorer prognosis than those with PMN count ﹤ 250 × 106 / L.