肝硬化时腹水感染引起的自发性腹膜炎

126例肝硬化患者因腹水细菌感染而致自发性腹膜炎。最常见的致病菌为大肠杆菌(46％),此外为肺炎链球菌(17％)、其他种类的链球菌(17％)、肺炎杆菌(8％)、厌氧或微量需氧菌(6％)。肝硬化患者由厌氧菌或微量需氧菌引起的自发性腹膜炎,其腹部表现与需氧菌所致的相似,常有反跳痛或肠鸣音减弱。由需氧菌引起的肝硬化自发性腹膜炎118例中,只有一种病菌者108例(92％),有多种病菌者仅10例(8％),而8例厌氧菌所致的自发性腹膜炎中,有4例(50％)为多种细菌感染。需氧菌性自发性腹膜炎同时发生菌血症者52例(44％),而8例厌氧或微量需氧菌性自发性腹膜炎中,仅1例并     

肝硬化少见并发症的诊治

乳糜性及血性腹水、肝性胸水、少见病原菌感染的自发性腹膜炎、肝硬化心肌病、门静脉性肺动脉高压、肝硬化神经系统损伤等肝硬化少见并发症,临床医生尚缺乏充分的认识和/或及时有效的诊治。现介绍上述肝硬化少见并发症的临床特征、治疗及预后,以提高临床医生的认识和诊疗水平。     

酒精性肝硬化并发唾液链球菌性腹膜炎

自发性细菌性腹膜炎是失代偿期肝硬化患者常见的严重并发症之一,其腹水细菌培养阳性率较低,而能给出阳性培养结果的致病菌多为需氧革兰氏阴性杆菌,革兰氏阳性球菌和厌氧菌等相对少见。我们报告了较为少见的唾液链球菌引起的自发性细菌性腹膜炎1例,并对提高其检出率和临床诊断率进行了分析。     

肝硬化并发自发性腹膜炎29例临床分析

自发性腹膜炎（SBP）是肝硬化患者常见及严重的并发症之一，其临床表现多不典型而易延误诊治，早期诊断并有效治疗是改善肝硬化患者预后的重要因素。现对我院2005年8月～2006年7月收住的29例肝硬化并发自发性腹膜炎患者临床资料回顾性分析如下。     

隐源性肝硬化并发自发性细菌性腹膜炎及多浆膜腔积液1例

正隐源性肝硬化又称特发性肝硬化,可进展为肝癌,但发生肝癌的比例较乙型肝炎肝硬化低,随年龄增长呈上升趋势。本文报道1例隐源性肝硬化并发自发性腹膜炎及多浆膜腔积液病例,旨在加强临床医生对此病的认识,以免误诊。1病例资料1.1主诉患者,男性,38岁,因"腹胀2+月"于2012年12     

双歧杆菌三联活菌胶囊联合抗菌治疗对肝硬化自发性细菌性腹膜炎患者肠黏膜屏障功能的影响以及临床疗效分析

[目的]观察双歧杆菌三联活菌胶囊联合抗菌治疗对肝硬化自发性细菌性腹膜炎(SBP)患者肠黏膜屏障功能的影响,以及分析其相关的临床疗效。[方法]选取2014年6月~2016年4月我院收治的肝硬化自发性细菌性腹膜炎患者86例,分为对照组和治疗组,每组43例。对照组常规抗菌对症治疗,治疗组在对照基础上加用双歧杆菌三联活菌胶囊(630mg,3次/d),14d为一疗程。ELISA法检测腹水中IL-6、TNF-α、IL-10表达,以及血液中DAO和D-乳酸表达,评价临床疗效。[结果]治疗前2组肝硬化自发性细菌性腹膜炎患者腹水IL-6、TNF-α、IL-10表达差异无统计意义(P0.05),治疗后治疗组IL-6和TNF-α显著低于对照组(P0.01),而IL-10又显著高于对照组(P0.01)。治疗前2组肝硬化自发性细菌性腹膜炎患者外周血DAO和D-乳酸差异无统计学意义(P0.05),治疗后治疗组DAO和D-乳酸均显著低于对照组(P0.01)。治疗组临床治疗有效率为90.70%,显著高于对照组的72.09%(P0.05)。[结论]双歧杆菌三联活菌胶囊联合抗菌药物治疗可以调节肝硬化自发性细菌性腹膜炎患者的炎症免疫紊乱状态,保护肠黏膜屏障,有利于损伤肠黏膜功能的恢复,临床疗效显著。     

红外热像图诊断自发性细菌性腹膜炎的应用研究

目的 利用红外热像图协助乙型肝炎肝硬化合并自发性细菌性腹膜炎的诊断。方法对43例乙型肝炎硬化腹水合并自发性细胞性腹膜炎患者和35例单纯乙型肝炎肝硬化腹水患者的腹部红外热像图进行对照研究结果实验组与对照组病人腹部红外热像图相比有特征性改变，两组间腹部红外热像图温度存在显著差异。结论 红外热像图协助诊断自发性细菌性腹膜炎具有简单易行，无创、费用低廉等特点，自临床应用价值。     

29例肝硬化肝性胸水并发自发性细菌性脓胸临床分析

自发性细菌性腹膜炎(SBP)是肝硬化患者常见的并发症。肝硬化肝性胸水患者中自发性细菌性脓胸(SBEM)临床上并非罕见，本文对我院及山东大学齐鲁医院近6年来住院的肝硬化肝性胸水患者合并SBEM情况进行了回顾性分析，以期达到早期诊断、及时治疗及提高肝硬化生存率的目的。     

肝硬化并发自发性腹膜炎患者腹水培养病原菌特征及耐药性分析

本研究回顾性总结2001年至2005年我院住院肝硬化并发自发性腹膜炎患者腹水病原菌特征、耐药性以及产酶率，以了解引起自发性腹膜炎细菌学特点，为临床合理用药提供依据。     

失代偿期肝硬化腹水并发白发性细菌性腹膜炎52例临床分析

目的探讨失代偿肝硬化腹水并发自发性细菌性腹膜炎（SBP）的临床特点及治疗方法。方法回顾性分析52例肝硬化腹水并发SBP患者的临床资料。结果52例肝硬化腹水并发SBP患者中,腹水细菌培养阳性率为3．85％,致病菌以革兰阴性杆菌为主,多数患者缺乏典型腹膜炎的症状及体征。结论及时准确的早期诊断和有效抗菌素治疗可明显提高SBP患者的治愈率。     

自发性气单胞菌腹膜炎

自发性气单胞菌腹膜炎的发生在肝硬化腹水患者中并不罕见。本文就如何诊断及预防自发性气单胞菌腹膜炎,提高患者预后综述如下。     

Spontaneous bacterial peritonitis due to Brucella Melitensis in a cirrhotic patient.

Spontaneous bacterial peritonitis is a well-known entity, with a reported incidence of 15-20% in advanced cirrhotic patients. Escherichia coli and Klebsiella pneumoniae are the most common causes of spontaneous bacterial peritonitis; Brucella is extremely rare. We aimed to present one case of such a rare condition in a cirrhotic patient who also had hepatocellular carcinoma. Routine laboratory tests, abdominal ultrasonography and peritoneal fluid examinations were studied in a cirrhotic patient with ascites. Peritoneal fluid white blood cell count was 1300/mm3, with lymphocyte predominance (80%). Peritoneal fluid and blood culture both yielded Brucella melitensis. The patient also had a mass in the right lobe of the liver confirmed as hepatocellular carcinoma by biopsy. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments and with immunodeficiency such as hepatocellular carcinoma.     

肝炎肝硬化并发自发性细菌性腹膜炎治疗探讨

目的探讨肝炎肝硬化并发自发性细菌性腹膜炎的治疗。方法147例肝炎肝硬化并发自发性细菌性腹膜炎患者行综合治疗:1积极支持治疗;2舒普深抗感染,每日4克,共3周;3每次放腹水后使用罗氏芬1克,腹腔注射。同期另118例肝炎肝硬化并发自发性细菌性腹膜炎患者,接受积极支持治疗和舒普深抗感染,每日4克,共2周。结果与对照组比,抗感染3周疗程加放腹水组患者腹水消退快,总胆红素下降明显,腹腔感染控制较彻底,一年后自发性细菌性腹膜炎复发率显著降低(P<0.05)。结论肝炎肝硬化并发自发性细菌性腹膜炎的抗感染治疗疗程要长,适时放腹水可提高疗效。     

Spontaneous bacterial peritonitis caused by Brucella melitensis

This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis in a 67-y-old male with congestive heart failure. Ten cases of reported previously brucella peritonitis are reviewed, 3 of which were ascitic fluid culture negative.     

Spontaneous bacterial peritonitis due to Brucella melitensis

Peritonitis is an extremely rare complication of brucellosis. A case is reported of blood and ascitic culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis, in a patient who had also cirrhosis.     

Procalcitonin is not an accurate marker of spontaneous bacterial peritonitis in patients with cirrhosis

BACKGROUND/AIMS: The clinical features of peritonitis are usually absent in cirrhotic patients with an ascitic fluid infection, raising the interest for specific biological markers of inflammation. METHODOLOGY: We prospectively measured the plasma and ascitic fluid levels of procalcitonin, an innovative infection parameter, interleukin-6, and C-reactive protein in 20 cirrhotics with or without spontaneous bacterial peritonitis. The patient's condition was followed-up for 12 weeks after paracentesis. RESULTS: None of the 10 patients with spontaneous bacterial peritonitis presented with severe systemic signs of infection. Procalcitonin level in plasma, but not in ascites, was significantly higher in patients with spontaneous bacterial peritonitis compared to controls (0.74 +/- 0.6 vs. 0.2 +/- 0.1 ng/mL, P < 0.05). Interleukin-6 levels in ascites were similar between groups. C-reactive protein concentrations were higher both in plasma and in ascitic fluid in patients with spontaneous bacterial peritonitis compared to controls (85.3 +/- 63 vs. 18.6 +/- 19 mg/dL, 24.6 +/- 25 vs. 4.5 +/- 4 mg/dL, P < 0.05, respectively). Three patients with spontaneous bacterial peritonitis died, but the outcome was not related to the concentrations of biological markers. CONCLUSIONS: In spontaneous bacterial peritonitis, procalcitonin measurement is not an accurate diagnostic test, possibly due to the absence of systemic inflammatory response syndrome in this condition. In addition, the diagnostic value of C-reactive protein is limited by the wide overlap between values.     

Diuresis increases ascitic fluid opsonic activity in patients who survive spontaneous bacterial peritonitis

Patients with low protein ascites and deficient ascitic fluid opsonic activity have been shown to be unusually predisposed to development of spontaneous bacterial peritonitis. Survivors of spontaneous peritonitis frequently develop recurrent infection. Diuresis has been shown to increase the ascitic fluid opsonic activity of patients who have never had spontaneous bacterial peritonitis. Patients with adequate opsonic activity are protected from ascitic fluid infection. Theoretically, the subset of patients who develop spontaneous peritonitis may have such severe liver disease that (i) their ascites is refractory to diuretic therapy or (ii) their ascitic fluid opsonic activity does not increase in response to diuresis. In this study, opsonic activity and concentrations of total protein and complement components were measured in the ascitic fluid of 11 patients who were hospitalized with spontaneous bacterial peritonitis and who responded to oral diuretics. The mean values of all of these parameters were found to increase significantly comparing the end-of-diuresis samples to the specimens that were diagnostic of ascitic fluid infection. Patients who survive spontaneous bacterial peritonitis are able to increase their ascitic fluid total protein and opsonic activity in response to diuresis. This increase in endogenous antimicrobial activity may help prevent recurrence of ascitic fluid infection.     

Spontaneous bacterial peritonitis in Saudi Arabian patients with non-alcoholic liver cirrhosis

BACKGROUND/AIMS: Spontaneous bacterial peritonitis is a frequent and serious complication of liver cirrhosis. Its prevalence varies from one survey to another. There are only very few reports of its occurrence among Arab patients. METHODOLOGY: We studied 115 Saudi Arabian patients with cirrhotic ascites in the Gizan region, an area of hyperendemic hepatitis B, over a 2-year period. RESULTS: Of these patients 12 (10.4%) had at least 1 episode of culture-positive spontaneous bacterial peritonitis (group A), an additional 34 (29.6%) had culture-negative neutrocytic ascites. The occurrence of spontaneous bacterial peritonitis was more frequent in males but was not influenced by the severity of liver disease or age. The overall mortality was 13.9%, however, only 1 patient died of spontaneous bacterial peritonitis-related cause. The remaining deaths were due to other complications of hepatic failure and portal hypertension. The low clinical threshold for treatment and the use of effective broad-spectrum antibiotics have reduced the mortality due to spontaneous bacterial peritonitis. There were a total of 56 recurrent episodes of infection in the patients. Of these episodes 46 occurred among 29 patients with spontaneous bacterial peritonitis and 10 among 62 patients with no infection during the index admissions. CONCLUSIONS: Prophylactic therapy against spontaneous bacterial peritonitis is a feasible strategy in reducing the frequency of recurrent peritonitis and should be recommended in these patients.     

Spontaneous bacterial peritonitis caused by Neisseria gonorrhoeae. Evidence for a transfallopian route of infection

We describe the clinical and laboratory features of a case of spontaneous bacterial peritonitis caused by Neisseria gonorrhoeae in a sexually active woman with Laennec's cirrhosis, ascites, and asymptomatic cervical gonorrhea. Treatment of the infection with high-dose parenteral penicillin was associated with resolution of the infection. This first report of spontaneous gonococcal peritonitis provides highly suggestive evidence that the transfallopian route is a mechanism whereby bacteria may enter the peritoneal cavity. Appropriate cultures for this organism should be included when a woman with chronic liver disease, who is sexually active, presents with spontaneous peritonitis.     

Brucella canis peritonitis

Although brucellosis is a common zoonotic disease worldwide, infection with Brucella canis is rare and often difficult to diagnose. We describe the clinical and epidemiological aspects of a case of B. canis peritonitis.