慢性重型肝炎和肝硬化并发自发性细菌性腹膜炎168例临床分析

目的　探讨慢性重型肝炎和肝硬化并发自发性细菌性腹膜炎 (SBP)菌株种类、临床特点和预后。方法　对 16 8例住院慢性重型肝炎和肝硬化并发SBP临床资料进行回顾性分析。结果　 14 2例 (85 71% )患者多核细胞 (PMN)相对值≥ 0 5 0。 32例腹水细菌培养阳性 ,共分离细菌 4 2株 ,大肠埃希菌占 4 2 % ,腹水蛋白≤ 10g/L并发SBP发生率高于腹水蛋白 >10g/L患者。两者差异显著 (P <0 0 5 )。结论　慢性重型肝炎和肝硬化并发SBP临床症状大多不典型 ,腹水PMN比值是诊断SBP比较可靠的参数。病原菌以大肠杆菌为主。腹水蛋白 <10g患者应警惕SBP发生 ,应及早做腹水常规检查     

重型肝炎并自发性腹膜炎34例分析

重型肝炎因肝衰竭而极易并发细菌感染,其中井发自发性细菌性腹膜炎(SBP)最为常见。重型肝炎并SBP者并发症多、病死率高、严重影响患者预后。我科自1996年3月～1999年2月收治重型肝炎101例,其中并发SBP34例,现分析报告如下。1 临床资料1.1 病例选择 1996年3月～1999年2月我院收治重型肝炎101例,其中伴有腹水者86例,发生SBP34例。重型肝炎诊断均符合病毒性肝炎防治方案(试行)(1995,北京)SBP诊断参考1988年全国腹水学术会议制订的标准。具体为:①发热、腹胀、腹痛;②腹膜刺激征;③腹水常规:WBC>0.5×10~9/L,PMN>0.5;④腹水细菌学检查阳性。凡具有①②③项中两项或单独④项即可诊断。1.2 临床表现 34例SBP中急性重型肝炎1例,亚急性重型     

放宽肝硬化腹水中性多核粒细胞的诊断标准对自发性细菌性腹膜炎的早期诊断价值

目的评价放宽肝硬化腹水中性多核粒细胞(polymorphonuclear, PMN)的诊断标准是否可以提高自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)的早期诊断。方法回顾性分析2012年4月至2016年12月首都医科大学附属北京佑安医院根据腹水培养阳性并存在临床可疑SBP症状诊断的SBP患者340例及无任何临床SBP表现且2次腹水培养阴性排除SBP的患者67例,完成腹水培养同时完善腹水常规检查,评价腹水PMN的不同取值对SBP的诊断效率。结果根据腹水PMN计数诊断SBP的诊断效率较高,ROC曲线下面积为0.95(95%CI:0.93～0.97);通过约登指数在ROC曲线上选取最佳cut-off值,cut-off=0.25×10~9 L~(-1)和cut-off=0.10×10~9 L~(-1)有相同的约登指数,均为0.7;当cut-off=0.25×10~9 L~(-1)时的诊断敏感性为74.4%,特异性100%,特异性较高,适合作为确诊指标;当cut-off=0.10×10~9 L~(-1)时的诊断敏感性为93.2%,特异性77.1%,敏感性较高,适合发现早期SBP。对腹水培养阳性的SBP患者,当腹水PMN的cut-off=0.10×10~9 L~(-1)时,假阴性率为6.5%;当腹水PMN的cut-off=0.25×10~9 L~(-1)时,假阴性率为19.1%,经配对χ~2检验,腹水PMN的不同取值对假阴性率的差异有统计学意义(P0.05)。当腹水PMN的cut-off=0.10×10~9 L~(-1)时,对SBP的敏感度更高,更容易发现早期SBP患者。结论腹水PMN计数是诊断SBP十分有效的诊断指标,当PMN≥0.25×10~9 L~(-1)时可以确诊SBP,但敏感度欠佳,漏诊率高达19.1%;以腹水PMN≥0.10×10~9 L~(-1)诊断SBP可明显降低SBP的漏诊率,可提高早期SBP的诊断效率,同时具有相对较高的特异性。     

慢性重型肝炎和肝硬化并发自发性细菌性腹膜炎的临床分析

自发性细菌性腹膜炎(SBP)是慢性重型肝炎(简称慢重肝)和肝硬化腹水常见并发症,多数为医院感染。对168例慢重肝和肝硬化腹水并发SBP患者的临床资料进行分析,旨在探讨SBP早期诊断,合理有效使用抗菌药物,减少SBP危险因素。     

血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析

目的 评估血清C-反应蛋白(CRP)和降钙素原(PCT)预测失代偿期肝硬化患者发生自发性细菌性腹膜炎(SBP)的临床价值。 方法 2014年12月～2018年6月我院住院的失代偿期肝硬化患者148例,检测血清CRP和PCT及腹水多形核细胞(PMN)计数,采用二分类Logistic回归分析和受试者工作特性曲线(ROC)下面积(AUC)分析指标诊断SBP的效能。 结果 在148例失代偿期肝硬化患者中,诊断SBP 90例,非感染性腹水患者58例;SBP患者Child-Pugh评分为(11.5±1.4),显著高于肝硬化患者,腹水PMN计数为 280.0(61.5,582.0)×10⁶/L,显著高于肝硬化患者,外周血WBC计数为(7.5±3.2)×10⁹/L,显著高于肝硬化患者,血清PCT为[3.91(1.32,9.61)ng/ml,显著高于肝硬化患者, 血清CRP为(32.0±21.7)mg/L,显著高于肝硬化患者; Logistic回归分析结果显示腹水PMN计数、血清PCT和CRP水平是失代偿期肝硬化患者发生SBP的独立危险因素(P均<0.05);腹水PMN计数、血清PCT和CRP诊断SBP敏感性分别为75.6%、73.3%和72.2%,特异性分别为68.9%、75.6%和88.9%,而以血清PCT=0.45ng/ml和CRP=12.68 mg/L为同时必须达到的标准,结果联合检测诊断SBP的敏感性为66.7%,特异性为90.0%。结论 检测腹水PMN计数及血清PCT和CRP水平有助于早期诊断失代偿期肝硬化患者并发SBP,对早期治疗有很大的益处。     

终末期肝病并自发性腹膜炎109例临床分析

目的分析终末期肝病患者并自发性腹膜炎的临床特征。方法以重型肝炎、肝硬化及原发性肝癌患者为研究对象,详细记录其临床症状、体征及实验室检查,根据腹水培养及药敏试验结果选择合适的抗生素,观察其疗效及转归并判断其预后。结果终末期肝病并自发性腹膜炎(SBP)109例,占所观察532例肝病患者的20.49%,其中,重型肝炎占46.53%(47/101),肝硬化占14.61%(52/356),原发性肝癌占13.33%(10/75),分别死亡27例、4例和3例;外周血白细胞>10.0×109/L者29例(26.61%),中性粒细胞分类>0.7者62例(56.88%),体温>38℃者21例,腹水培养阳性率为19.26%,其中大肠埃希菌占培养阳性者占38.10%,治疗有效率为66.06%。结论终末期肝病并SBP临床表现不典型,存在脾功能亢进,白细胞减少,腹水培养阳性率低,因此以腹水白细胞、多形核细胞及血白细胞分类作为诊断SBP的主要依据。重型肝炎并SBP发生率高于肝硬化及肝癌,同时三者的病死率均高于不并发SBP者。因此,预防SBP的发生,给予敏感药物积极有效治疗SBP对提高终末期肝病患者疗效及改善预后有积极意义。     

肝硬化腹水并发自发性腹膜炎50例临床分析

目的探讨肝硬化并发自发性细菌性腹膜炎（SBP）的特点,为科学治疗提供临床指导。方法回顾性分析50例肝硬化并发SBP患者的临床资料。结果50例患者中。发热37例（74．0％）,腹胀41例（82．0％）,腹痛30例（60．0％）,腹水多形核白细胞（PMN）比值〉0．50者43例（86．0％）,腹水细菌培养阳性27例（54．0％）。结论肝硬化并发SBP临床表现不典型．腹水PMN比值是诊断SBP的敏感指标之一。大肠杆菌为该疾病主要病原菌,对头孢噻肟和第三代喹诺酮类药敏感,可作为首选药物。     

丽珠肠乐治疗肝硬化并发自发性细菌性腹膜炎的临床分析

自发性细菌性腹膜炎(SBP)是肝硬化严重的并发症及死亡原因之一,近年来,我们用丽珠肠乐治疗肝硬化并发SBP,取得良好的疗效,现总结报告如下:1材料与方法1·1研究对象83例肝炎肝硬化并发SBP病例均为1999年1月~2005年1月来我院住院的患者,SBP诊断标准为:①发热;②腹痛、腹部压痛及反跳痛;③腹水迅速增加,用利尿剂无效;④腹水白细胞等于或大于500×106/L;⑤白细胞少于250×106/L时,多形核白细胞(PMN)比值等于或超过0·50,或PMN绝对计数大于或等于250×106/L。其中④、⑤两条必须具备一条。随机分为2组,治疗组42例,其中男性26例,女性16例…     

血清降钙素原和C反应蛋白对肝硬化腹水自发性细菌性腹膜炎的预判价值

目的探讨血清降钙素原(PCT)和C反应蛋白(CRP)对肝硬化腹水自发性细菌性腹膜炎(SBP)的预判价值。方法回顾性分析孝感市第一人民医院2012年5月至2017年5月收治的200例肝硬化腹水患者的临床资料,根据其是否并发SBP分为并发SBP组(100例)、未并发SBP组(100例),并以50例健康者作健康组。对比分析各组患者的临床资料,对比分析各组PCT、CRP、WBC水平,评价其敏感度和特异性。结果肝硬化腹水并发SBP组的PCT为(3. 86±1. 56)μg/L、CRP为(38. 87±11. 54) mg/L,相比肝硬化腹水未并发SBP组和健康组均明显升高,具有显著差异(P 0. 05);肝硬化腹水并发SBP组的WBC为(6. 25±1. 68)×10~9/L、肝硬化腹水未并发SBP组为(5. 89±1. 82)×10~9/L、健康组为(5. 72±1. 65)×10~9/L、三组WBC无明显差异(P 0. 05)。PCT联合CRP检测肝硬化腹水自发性细菌性腹膜炎(SBP)的敏感性为92. 5%,特异性为90. 0%,均高于单独检测结果。并发SBP组治疗后PCT、CRP明显下降(P 0. 05),未并发SBP组PCT、CRP治疗前后无显著性差异(P0. 05)。结论 PCT和CRP在肝硬化腹水并发SBP诊断中均具有较高的价值,充分结合两种方法可以进一步提供诊断准确率,值得临床推广应用。     

肝硬化并发自发性细菌性腹膜炎临床分析

目的探讨肝硬化并发自发性腹膜炎的临床特点。方法回顾性统计分析73例失代偿期肝硬化临床资料。结果多数患者缺乏腹膜炎的症状、体征,腹水细菌培养阳性率14%。结论肝硬化并发SBP的诊断不能单纯依赖腹水中的细胞计数而PMN计数是诊断SBP的重要指标。     

186例晚期肝病患者并发原发性腹膜炎的诊断与治疗

目的 为提高治疗晚期肝病患者并发原发性腹膜炎的疗效,改善预后。方法 以肝硬化、重型肝炎伴发腹膜炎患者为研究对象,详细记录患者的体温、腹部症状、体征、血象、腹水中多核细胞数和腹水培养情况。在输注血浆、白蛋白等对症支持治疗的基础上,根据药敏试验和临床经验使用适当的抗菌素,观察患者体温、腹部症状及体征的转归情况。结果 同期收治的晚期肝病患者275例中确诊或疑诊为原发性腹膜炎患者共186例,伴有不同程度的腹胀、腹痛、腹部压痛和张力增高等症状体征,感染率约67.6％。体温高于37.4℃ 138例;外周血白细胞计数大于10×10~9/L 106例;中性粒细胞分类大于80％有137例;腹水中多核细胞计数大于250个/mm~3 103例。腹水培养结果仅29例患者细菌培养阳性。治愈82例,好转17例,无效、恶化18例,死亡69例。结论 晚期肝病伴发腹膜炎的症状体征不够典型,腹水培养阳性率低,及时有效的使用合适的抗菌素治疗,能提高疗效、改善预后。     

Spontaneous bacterial peritonitis: occurrence in chronic liver disease patients in Recife]

A prospective research was made on spontaneous bacterial peritonitis (SBP) in chronic liver disease patients presenting with ascites. Forty clinical cases, of 37 patients, were analysed. All subjects were submitted to clinical and laboratory evaluation and diagnostic paracentesis, and the material was obtained for biochemical dosages, pH determination, cytology and bacterial cultures. Thirty cases of sterile ascites and 10 of SBP (25%) were detected. In 5 (50%) with SBP, the clinical findings were characteristic, with fever, abdominal pain and rebound tenderness. In 2 patients (20%) the presentation was atypical, without the complete triad described above. Finally in 3 (30%) SBP was silent, without any suggestive clinical manifestations of infection. In 7 cases (70%) cultures were positives; Streptococcus pneumoniae (3 cases), Streptococcus pyogenes, Staphylococcus negative coagulase, Staphylococcus aureus and Klebsiella pneumoniae (one case each). In 7 (70%) SBP cases, the patients were admitted already infected in the hospital. Lethality in the SBP group was 30% and in the sterile ascites was 13.3%. We concluded that SBP is a frequent cause of morbid-lethality in patients with ascites and chronic hepatopathy, presenting itself often in a typical clinical manifestations.     

Spontaneous bacterial peritonitis]

Patients with liver cirrhosis and ascites suffer from spontaneous bacterial peritonitis (SBP) in up to 25%. The typical clinical signs are abdominal pain with tenderness and fever. 30% have no signs of peritonitis. Then clinical worsening, encephalopathy, rising serum creatinine levels, and therapy resistant ascites may be the only clinical features. SBP must be differentiated from bacterascites and culture negative neutrocytic ascites by the polymorphonuclear neutrophil (PMN) count in the ascites and the presence of positive culture results, which has prognostic implications. Gram negative rods from the colon play an important etiological role in SBP. Gastrointestinal bleeding, lack of serum complement, a low ascites protein and the extent of intrahepatic shunts predispose to SBP. Then, prophylaxis with the comparable drugs neomycin and norfloxacin is indicated. Coexisting encephalopathy has to be treated by the therefore effective neomycin. Otherwise, norfloxacin is the drug of choice because of better acceptance and lower costs. Chemical parameters of the ascites (pH value less than 7.4; LDH and lactate greater than serum levels; glucose less than 50 mg%) help to assess the severity of peritonitis. The course of ascitic PMN under therapy and the time of persisting positive cultures can discriminate SBP from secondary peritonitis. Antibiotics of choice are amoxicillin-clavulanic acid and cefotaxime. Short course therapy (5 days) is a effective as long course therapy (10 days). Today SBP is no more life-threatening because diagnosis, prophylaxis and therapy have improved. However, complication rate of patients with liver cirrhosis and ascites has not changed.     

慢性重型肝炎合并原发性腹膜炎96例临床分析

目的:探讨慢性重型肝炎合并原发性腹膜炎的临床特点及预后,旨在尽早诊断,早治疗,提高生存率。方法:对96例慢性重型肝炎合并原发性腹膜炎住院患者的临床资料进行回顾性分析。结果:发热15例(15.6%),腹膜刺激征阳性41例(42.7%),腹胀64例(66.7%),腹痛18例(18.8%),移动性浊音阳性47例(48.9%)。结论:慢性重型肝炎合并原发性腹膜炎临床表现不典型、多样性。预后主要与慢性重型肝炎的严重并发症有关。     

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

AIM： To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis （SBP） in clinical practice.
METHODS： All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear （PIN） cell count was 〉 250 cells/mm^3, and empirically treated with cefotaxime.
RESULTS： Thirty-eight SBP episodes occurred in 32 cirrhotics （22 men/20 women; mean age： 58.6 ＋ 22.2 years）. Prevalence of SBP, in our population, was 27%. Ascitic fluid culture was positive in nine （24%） cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage （44%） similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. CONCLUSION： In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment andevaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.     

The spontaneous bacterial peritonitis in cirrhotic patients. To a new gold standard.

Of 282 consecutive ascites prospectively collected in 54 months, Spontaneous Bacterial Peritonitis (SBP) was diagnosed in 8.5% of the cases, "probable" SBP in 31.1%, Bacteriascites (BA) in 3.5% and Sterile Ascites (SA) (negative ascitic fluid culture with PMN less than 250/mm3) in 74.8%. Escherichia Coli (41.6%) and Staphylococcus Epidermidis (60%) were the most frequent pathogens isolated in patients with SBP and BA, respectively. With regards to in-hospital mortality, 18% of patients with BA and 50% with SBP died; the mortality seemed to be related to the degree of hepatic and renal damage, to a higher peripheral and ascitic WBC concentration and to a lower pH of ascitic fluid (FA). When the comparative analysis was applied to the four groups of ascites, a different distribution of clinical signs and biohumoral parameters appeared. As a matter of fact, abdominal pain, fever and rebound tenderness resulted significantly more frequent in SBP and "probable" SBP. Furthermore, the mean values of peripheral and ascitic WBC concentration, of serum creatinine and of ALT were statistically higher in SBP and "probable" SBP than in SA and BA groups. The strict relationship, both symptomatologic and biochemical, between SA and BA on the one hand and between "probable" SBP and SBP on the other, prompted us to conclude that "probable" SBP and SBP represent different patterns of the same disease. Therefore, the subclassification in the four groups outlined above would not be in accordance with the clinical practice and could give rise to the physician's confusion and uncertainty.     

Efficacy of leukocyte esterase dipstick test as a rapid test in diagnosis of spontaneous bacterial peritonitis

INTRODUCTION Apart from variceal bleeding, spontaneous bacterial peritonitis (SBP) is another serious complication that can develop in cirrhotic patients. Prompt diagnosis and treatment are essential for the survival of patients with SBP[1,2]. Unfortunate…     

Re-evaluation of the value of ascitic fluid pH lactate dehydrogenase and total proteins in the diagnosis of spontaneous bacterial peritonitis (SBP)

In view of high mortality, variable clinical presentation, and late results of bacterial culture, early diagnosis of SBP and treatment are based on indirect parameters of infection. Forty-two patients with ascites and liver cirrhosis were studied. Ascitic fluid (AF) was examined for total protein content, pH, lactate dehydrogenase, amylase, absolute polymorphonuclear cell count (PMN) and for presence of bacteria by examining a fresh smear of the deposit and culture of the fluid under aerobic and anaerobic conditions. AF/serum gradient of total proteins and LDH was calculated. One patient proved to have a malignant ascites and was excluded. The remaining 41 patients fell into two groups: Group I PMN less than 250 cell mm-3, culture negative, sterile ascites, 36 patients. Group II PMN greater than 250 cell mm-3. (a) Culture positive neutrophilic ascites (SBP), three patients. (b) Culture negative neutrophilic ascites (CNNA), two patients. In both CNNA and SBP:AF/serum total LDH gradient greater than 0.75 In the sterile group: AF/serum total LDH gradient less than 0.58 There was no correlation between presence of infection and ascitic fluid pH, protein content and AF/serum total protein gradient. Therefore AF PMN greater than 250 mm and AF/serum total LDH gradient greater than 0.6 should be considered reliable, indirect parameters of infection, and CNNA a variant of SBP with a small bacterial inoculum size.     

细菌感染性腹泻2380例临床及病原学分析

目的 了解细菌感染性腹泻的临床及病原学特点.方法 回顾性分析1998年至2007年复大学附属金山医院感染性腹泻患者2380例的临床及细菌学特点.计数资料行X~2检验.结果 10年间因腹泻就诊的20 169例患者中,2380例粪细菌培养阳性,包括副溶血弧菌感染2247例,占94.4%,志贺菌属感染99例,占4.2%,沙门菌属感染29例,占1.2%,溶藻弧菌感染3例,致病性大肠埃希菌感染2例.因腹泻就诊者在每年6至10月多见,副溶血弧菌感染主要表现为腹痛、腹泻、恶心、呕吐,可伴有脱水,志贺菌属感染主要表现为发热、腹痛、腹泻.结论 上海市金山区细菌感染性腹泻患者粪细菌培养阳性率不高,仍以副溶血弧菌、志贺菌属为主要致病菌.