细菌性腹水患者病原菌分布、实验室指标及预后情况分析

Analysis of pathogenic bacteria distribution,laboratory indicators and prognosis in patients with bacterial ascites

目的探讨细菌性腹水患者的临床特征、实验室指标及预后情况,为临床早期诊断和治疗提供依据。方法回顾性分析2019年1月至2022年1月天津中医药大学第一附属医院诊断为肝硬化腹水患者的临床资料,根据诊断标准将其分为细菌性腹水组(n=24)、自发性细菌性腹膜炎组(n=20)与对照组(n=26)。比较三组患者的临床特征、实验室指标及预后情况。结果由乙型肝炎引起的肝硬化腹水占比最高。细菌性腹水组患者的血白细胞计数、中性粒细胞百分比、腹水白细胞计数及多形核白细胞计数均显著高于对照组(P<0.05)。革兰阳性菌是引起细菌性腹水的最主要病原体,其中葡萄球菌占比最高。有感染症状的10例细菌性腹水患者,进行腹水培养同时给予抗感染治疗,病情均好转;无感染症状的14例患者,根据病情发展给予不同的治疗方案,1例患者死亡,其余患者病情好转。结论临床中细菌性腹水患者数量较大,主要致病菌为革兰阳性球菌;将临床症状与实验室指标结合,有利于细菌性腹水的早期诊断,并决定治疗方案。

Objective To investigate the clinical features,laboratory indicators and prognosis of patients with bacterial ascites,and to provide evidence for early clinical diagnosis and treatmen.Methods Clinical data of patients diagnosed with cirrhosis ascites from First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to January 2022 were retrospectively analyzed.According to diagnostic criteria,they were divided into bacterial ascites group(n=24),spontaneous bacterial peritonitis group(n=20)and control group(n=26).The clinical features,laboratory indicators and prognosis of three groups were compared.Results Cirrhosis ascites caused by hepatitis B accounted for the highest proportion.The white blood cell count,neutrophil percentage,ascites white blood cell and polymorphonuclear leukocyte count of patients in bacterial ascites group were significantly higher than those in control group(P<0.05).Gram-positive bacteria was the main pathogens causing bacterial ascites,among which staphylococcus accounts for the highest proportion.Ten cases of bacterial ascites with symptoms of infection were treated with ascites culture and anti-infection therapy.The 14 patients without symptoms of infection were given different treatment according to the development of the disease,one patient died,and the other patients improved.Conclusion The number of patients with bacterial ascites was large,and the main pathogenic bacteria was Gram-positive coccus.The combination of clinical symptoms and laboratory indicators is beneficial to the early diagnosis of bacterial ascites and the decision of treatment.