54例结核性腹膜炎临床分析

目前医疗条件普遍较好，但结核性腹膜炎的误诊率仍较高。目的：通过分析结核性腹膜炎的临床特点，探讨其实用诊断方法。方法：回顾性分析2002年1月-2007年8月安徽省计划生育学校附属医院确诊的54例结核性腹膜炎患者的临床特点。结果：结核性腹膜炎的误诊率为27．8％，各项辅助检查的阳性率分别为血常规异常37．0％（20／54），血细胞沉降率增快75．9％（41／54），结核菌素试验阳性63．0％（34／54），抗结核抗体阳性48．1％（26／54），血清转铁蛋白下降85．2％（46／54）．腹水腺苷脱氨酶（ADA）活性增高59．1％（13／22），胃镜检查阳性56．2％（9／16），腹腔镜检查阳性87．5％（7／8）。结论：腹腔镜检查和血清转铁蛋白对结核性腹膜炎的诊断阳性率最高，但前者有创伤性，后者缺乏特异性。血清转铁蛋白检测可能为结核性腹膜炎的临床诊断提供了一种新方法。应结合患者的临床表现、各项辅助检查和抗结核治疗的疗效诊断结核性腹膜炎。

Clinical Analysis of 54 Cases of Tuberculous Peritonitis

Background： Tuberculous peritonitis still has a high misdiagnosis rate although the advanced medical equipments are available. Ahns： To explore the practical diagnosis methods of tuberculous peritonitis through analysis of clinical characteristics of tuberculous peritonitis. Methods： Clinical characteristics of 54 cases of tuberculous peritonitis diagnosed in Affiliated Hospital of Anhui Family Planning School from Jan. 2002 to Aug. 2007 were analyzed retrospectively. Results： Misdiagnosis rate of tuberculous peritonitis was 27.8%. Routine blood test was abnormal in 37.0% （20/54）, blood sedimentation rate increased in 75.9% （41/54）, positive tuberculin test in 63.0% （34/54）, positive anti-tuberculous antibody in 48.1% （26/54）, serum transferrin decreased in 85.2% （46/54）, activity of ascites adenosine deaminase （ADA） increased in 59.1% （13/22）, gastroscopy showed positive findings in 56.2% （9/16）, and positive peritoneoscopy in 87.5% （7/8）. Conclusions： The positivity rates of peritoneoscopy and serum transferrin are the highest, but the former is invasive and the latter is nonspecific. However, serum transferrin may be a new method for the diagnosis of tuberculous peritonitis. Diagnosis of tuberculous peritonitis should be made on the basis of clinical characteristics, auxiliary examinations and the efficacy of anti-tuberculous therapy.