肝硬化腹水合并自发性细菌性腹膜炎患者临床特征与血清指标分析

Analysis of Clinical Features and Serum Indicators of Patients With Hepatocirrhosis Ascites Complicated With Spontaneous Bacterial Peritonitis

目的分析肝硬化腹水合并自发性细菌性腹膜炎(SBP)患者的临床特征与血清指标。方法回顾性分析91例肝硬化腹水并SBP患者临床资料,分析其临床特征、实验室检查结果及病原学检查结果,在接受保肝、利尿等治疗后,观察血清指标的变化。结果临床症状以体温升高、腹胀、腹痛为主,少数出现腹肌紧张、反跳痛等;外周血检查:有47例白细胞(WBC)升高,66例粒细胞(PMN)升高;腹水检查:70例患者腹水WBC升高,68例粒细胞PMN升高;病原学检查:36例细菌培养呈阳性,检出病原菌共38株,其中革兰阳性菌13株,革兰阴性菌25株;治疗后患者血清丙氨酸氨基转移酶(ALT)、总胆汁酸(TBA)、血清补体C3及C4水平均较治疗前均明显改善(P<0.05)。结论肝硬化腹水并SBP患者临床主要表现为体温升高、腹胀腹痛等,其实验室检查显示外周血和腹水WBC、PMN均明显升高,其主要感染菌群为革兰阳性菌,接受相关治疗后可有效改善其血清指标异常。

Objective To analyze the clinical features and serum indicators of patients with hepatocirrhosis ascites complicated with spontaneous bacterial peritonitis(SBP).Methods The clinical data of 91 cases of patients with hepatocirrhosis ascites and SBP treated were analyzed retrospectively.The clinical features,laboratory test results and etiological findings were analyzed.After receiving liver protection,diuresis and other treatments,the changes of serum indicators were observed.Results The clinical symptoms were mainly elevated body temperature,abdominal distension and abdominal pain,with a few cases of abdominal muscle tension and rebound pain.Peripheral blood examination showed 47 cases of white blood cell(WBC)increase and 66 cases of polymorphonuclear(PMN)increase.Ascites examination showed there were 70 cases of increased WBC in ascites and 68 cases of increased PMN.Etiological examination showed there were 36 cases of positive bacterial culture and a total of 38 pathogenic bacteria were detected,including 13 Gram-positive bacteria and 25 Gram-negative bacteria.After treatment,the levels of serum alanine aminotransferase(ALT),total bile acid(TBA),serum complement C3 and C4 were improved compared to before treatment(P<0.05).Conclusion The main clinical manifestations of patients with hepatocirrhosis ascites complicated with SBP include elevated body temperature,abdominal distension and abdominal pain.The laboratory test shows that the WBC and PMN in peripheral blood and ascites are significantly increased,and the main infection flora is Gram-positive bacteria,and it can effectively improve the abnormal serum indicators after receiving relevant treatment.