126例结核性腹膜炎临床分析

目的分析结核性腹膜炎的临床特点,探讨其诊断和治疗方法。方法分析2002年3月~2009年1月我院确诊126例结核性腹膜炎患者的临床特点。结果各项检查的阳性率分别为血沉增快79.3%（100/126）,PPD阳性62.2%（74/119）,血结核抗体39.7（50/126）,腹部B超78.6%（99/126）,腹部CT 48.7（38/78）,胸部X线片40.5%（51/126）,腹水腺苷酸脱氨酶（ADA）活性增高73.9（34/46）,腹腔镜检查阳性88.9%（16/18）,腹膜活检100%（6/6）,通过各项诊断方法及时诊断,合理用药,治疗总有效率达80.15%。结论联合不同诊断方法,正确诊断,联合长期用药,必要时配以手术治疗,可提高结核性腹膜炎的临床诊治水平。     

老年人结核性腹膜炎26例临床分析

本文收集了我院20年来60岁以上的结核性腹膜炎26例进行临床分析,结果表明老年结核性腹膜炎有一定的发病率,病程长,结核中毒症状不明显,应引起高度重视.1 临床资料1.1 一般资料:我院1976年～1996年共收治结核性腹膜炎116例,其中60岁以上老年人26例,占总     

糖皮质激素治疗结核性腹膜炎的临床体会

目的:探讨糖皮质激素应用于渗出型结核性腹膜炎(tuberculous peritonitis,TBP)的适应证和方法以期达到最佳疗效.方法:以同期30例渗出型TBP为研究对象,抗结核治疗2 wk后加用糖皮质激素治疗.依疗效将患者分为A组(显效和有效)和B组(无效或恶化),对比分析2组病例的基本情况、临床表现、合并症、辅助检查、治疗效果和预后.结果:A组18例,B组12例,两组平均年龄(29.1岁±10.2岁vs 48.5岁±20.8岁,P<0.05).A、B两组合并症如下:黏连型T B P,肠结核,结核性胸膜炎,卵巢结核(2/18 vs 9/12,1/18 vs2/12,12/18 vs 2/12,1/18 vs 2/12,P<0.05).A组高热12例,中度发热5例;B组中度发热5例,低热7例.A组结核菌素试验强阳性10例,阳性8例;B组阳性5例,弱阳性7例.A组10例血沉>100 mm/h,4例血沉50-100 mm/h,1例血沉≥20 mm/h且<50 mm/h;B组2例血沉50-60mm/h,10例血沉≥20 mm/h且<50 mm/h.A组中大量腹水8例,中量腹水10例;B组中量腹水3例,少量腹水9例.A组14例显效,尿量增加300-500 mL/d,腹胀明显减轻;4例有效,尿量增加200-350 m L/d,腹胀减轻.使用激素4wk后复查提示少量腹水,6-8 wk后腹水消失.B组12例无效,腹水无明显减少,腹胀未好转.5-8 wk后腹水消失.随访6 mo,所有病例未发现疾病进展,未出现相关并发症,恢复良好.结论:糖皮质激素主要适用于变态反应强烈的渗出型TBP.在规律抗结核治疗2 wk后遵循短期、小量、顿服、递减的原则应用糖皮质激素是安全有效的.     

结核性腹膜炎的诊断现状

结核性腹膜炎的诊断在结核病较常见的国家仍是一项挑战。该病的临床表现无特异性。以淋巴细胞为主的腹膜炎和低血清-腹水白蛋白梯度(＜11g/L)的患者应考虑结核性腹膜炎可能。腹水培养结核杆菌和经腹腔镜取腹膜活检标本是诊断结核性腹膜炎的重要方法。并讨论多聚酶链反应,腺苷脱氨酶和其他方法诊断结核性腹膜炎的价值。     

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。     

结核性腹膜炎的诊断与治疗

结核性腹膜炎(tuberculous peritonitis,TBP)可发生于任何年龄,但以20～40岁为最多,占61.5%～78.5%。女性多于男性,男女之比为1:1.4～1.8。生活贫困、酗酒、使用激素或免疫抑制剂、慢性肾功能衰竭行移动性腹膜透析患者和爱滋病感染者易患本病。由于结核病防治工作的广泛开展,TB     

腹膜活检对结核性腹膜炎的诊断价值

目的评价经皮腹腔穿刺腹膜活检对结核性腹膜炎的诊断价值。方法使用自动弹簧活检针对34例临床上考虑为结核性腹膜炎患者进行腹膜活检,并进行病理诊断。结果34例患者均经一次穿刺取出腹膜壁层组织,经病理证实结核性腹膜炎26例、转移性腺癌3例、恶性淋巴瘤1例和大致正常腹膜组织4例,一次穿刺活检成功率为100％,经活检明确腹水病因的诊断率为88．2％。结论腹膜活检对结核性腹膜炎诊断及鉴别诊断,有重要的临床诊断价值。     

结核性腹膜炎伴胃壁结核性脓肿一例

患者女,30岁。因反复剑突下疼痛2年余,加重伴呕吐2个月,门诊发现腹水收入院。疼痛为隐痛或钝痛,反复发作,偶伴反酸、打呃,劳累、饥饿及夜间易发,进食后可缓解。2个月前疼痛加重,持续时间延长,并出现恶心呕吐,病后曾呕吐暗红色液体1次,解柏油样大便多次,体重明显减轻,饮食减少,曾有数次停经数月史,现已停经1年余。胃镜示慢性浅表性胃炎及十二指肠溃疡。诊断性刮宫,病理报告为“炎性坏死物”。入院体检:消瘦,左下腹扪及6cm×5cm包块。白细胞4 .2×10 9/L ,中性0 .6 5 ,淋巴0 .33,单核细胞0 .0 2 ,红细胞4 .18×10 12 /L ,血红蛋白12 3g/L,肝…     

Presentation and role of peritoneoscopy in the diagnosis of tuberculous peritonitis

This study represents the clinical and laboratory features of 135 tuberculous peritonitis cases in whom peritoneoscopic investigation was used routinely. Disease was more common in women than men (1.5:1) and was most frequently encountered in the third and fourth decades in life. The most common presenting symptoms were abdominal distension (96%), abdominal pain (82%), weight loss (80%), weakness (76%), loss of appetite (73%) and fever (69%). The most common physical findings were ascites (96%), fever (75%) and abdominal tenderness (43%). One hundred and twenty-nine cases (95.5%) showed exudative type tuberculous peritonitis with variable amounts of ascites and filmy adhesions. In six patients (4.5%) the disease was of the plastic (dry) type. Peritoneoscopic investigations of 139 patients suggested tuberculous peritonitis but four cases showed histologically proven malignancy (3%). Laparoscopic diagnoses of the remaining cases were confirmed by histology (97%). The laparoscopic appearance of scattered yellowish-white nodules, approximately 1-5 mm in size, on the peritoneal surfaces, and filmy adhesions were suggestive of tuberculous peritonitis. A non-fatal colon perforation occurred as a major complication. After antituberculous therapy patients were followed for at least 1 year. Peritoneoscopy with simultaneous biopsy is the ideal and most accurate diagnostic modality in the diagnosis of tuberculous peritonitis.     

结核性腹膜炎的CT表现

目的探讨结核性腹膜炎(TBP)的CT特点,提高其诊断水平。方法分析32例经临床及病理证实为TBP的CT表现。结果 (1)壁腹膜增厚21例,其中光滑增厚18例、不规则增厚3例;(2)肠系膜改变24例;(3)大网膜改变19例;(4)腹水26例;(5)腹腔淋巴结增大6例。结论 CT能够为临床诊断TBP提供有价值的线索。     

T淋巴细胞斑点试验在结核性腹膜炎诊断中的临床应用价值

[目的]研究T淋巴细胞斑点试验(T-SPOT.TB)在结核性腹膜炎临床诊断中的应用价值。[方法]对40例结核性腹膜炎、38例非结核性腹膜炎的患者的腹腔积液实施T-SPOT结核试验。[结果]40例结核性腹膜炎患者中T-SPOT.TB阳性36例(阳性率90.00%),对照组38例非结核性腹膜炎T-SPOT.TB阳性3例(阳性率7.89%)。[结论]T-SPOT.TB是一种鉴别腹腔积液是否为结核性腹膜炎的较好的方法,具有很好的临床应用价值。     

CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis

BACKGROUND: Most malignancies with peritoneal infiltration, especially ovarian cancers and chronic liver diseases associated with ascites give rise to high serum CA-125 levels. Tuberculous peritonitis is another cause for high serum CA-125 levels. AIM: To investigate the relation between serum CA-125 level and response to treatment in tuberculous peritonitis patients. PATIENTS: Ten patients with tuberculous peritonitis were enrolled in the study. METHOD: Definite diagnosis of tuberculous peritonitis was made by acid-fast smears, specific culture, and polymerase chain reaction. Serum CA-125 levels were measured before and at the fourth month of treatment. RESULTS: Before antituberculous treatment, serum CA-125 levels of all patients were very high (mean+/-SD: 475. 80+/-106. 19 U/ml) and comparable with those of patients with ovarian cancers. At the end of the fourth month of treatment, serum CA-125 levels in all patients decreased to within normal limits (<35 U/ml)(20.80:+/-5.18 U/ml) in parallel with the clinical improvement. The differences in CA125 levels before and after treatment were statistically significant (p<0.001). CONCLUSIONS: Results of our study suggest that serum CA-125 levels in patients with tuberculous peritonitis are as high as ovarian cancers associated with peritoneal infiltration. By the end of the fourth month of antituberculous therapy, serum CA-125 levels have returned to normal. We, therefore, suggest that serum CA-125 can be used to evaluate the efficacy of therapy in tuberculous peritonitis.     

肝硬化腹水合并结核性腹膜炎12例首诊误诊分析

目的研究肝硬化腹水合并结核性腹膜炎首诊误诊为原发性细菌性腹膜炎及原发性肝癌性腹水的原因。方法对我院近14年来首诊误诊病例的临床资料进行详细分析比对。结果共12例首诊误诊病例,原因多种多样。结论提示临床医师对于在肝硬化腹水基础上合并结核性腹膜炎应予足够重视。     

肝硬化腹水并发结核性腹膜炎的预警指标分析

目的分析肝硬化腹水并发结核性腹膜炎预警指标。方法回顾性分析2010年1月至2012年12月重庆医科大学附属第二医院62例肝硬化腹水患者的临床资料。其中肝硬化腹水并发结构性腹膜炎(TBP)患者27例(TBP组);肝硬化腹水未发生TBP患者35例(非TBP组),收集2组患者的临床情况和实验室检查结果。采用χ2检验和Mann-Whitney U检验进行单因素分析;Logistic回归多因素检验进行多因素分析。结果性别、原发性腹膜炎病史、血沉(ESR)、血清结核抗体、腹水淋巴细胞为主(≥50%)及凝血酶原活动度(PTA)等指标在2组的差异具有统计学意义(P0.05)。原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞为主(≥50%)的肝硬化腹水患者发生结核性腹膜炎的OR分别为1.933、3.205、2.716、11.701;其工作特征曲线(ROC)下面积(AUC)分别是0.831、0.815、0.775、0.935,P值均0.05。结论既往有原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞≥50%是肝硬化腹水患者发生结核性腹膜炎的预警指标;各预警指标的预测价值均较好,尤其腹水淋巴细胞为主(≥50%)预测价值最大。     

血清-腹水白蛋白梯度和腹水腺苷脱氨酶对结核性腹膜炎的诊断价值

目的:探讨血清-腹水白蛋白梯度(serum-ascites albumin gradient,SAAG)和腹水腺苷脱氨酶(adenosine deaminase,ADA)对结核性腹膜炎的诊断价值。方法:选取458例腹水患者进行回顾性分析,并将其分为4组:单纯渗出性结核性腹膜炎组(Ⅰa组)39例,肝硬化合并结核性腹膜炎组(Ⅰb组)14例,肝硬化组(Ⅱa组)315例和其他原因组(Ⅱb组)90例。以所有患者血清白蛋白及腹水中的总蛋白浓度进行检测,计算出SAAG;并测定腹水中的ADA浓度。结果:Ⅰa组、Ⅰb组、Ⅱa组、Ⅱb组患者SAAG分别为6.97±1.81、8.24±2.15、20.32±5.24和17.40±4.83g/L;腹水ADA分别为55.06±12.34、49.21±9.96、10.24±3.65和16.88±5.72U/L。结果显示,SAAG和腹水ADA在Ⅰa组与Ⅱa组间,以及Ⅰb与Ⅱa组间比较差异均有显著性意义(P<0.01);而Ⅰa组与Ⅰb组间比较差异无显著性意义(P>0.05)。以SAAG<11g/L为临界值诊断结核性腹膜炎的敏感性为90.6%,特异性为95.6%,准确率为92.4%。以ADA>40U/L为临界值诊断结核性腹膜炎的敏感性为94.3%,特异性为95.6%,准确率为95.4%。结论:SAAG<11g/L,或腹水ADA>40U/L,尤其是后者,可作为诊断结核性腹膜炎的敏感指标。     

Tuberculous peritonitis

We report a case of tuberculous peritonitis in a 24-year-old male patient. On admission, he was complaining of abdominal fullness and fever. Ultrasound tomography and computed tomography (CT) scan of the abdomen showed massive ascites with multiple septa. The most interesting feature of this case was the diffuse and intense uptake of gallium-67 in the abdomen. Though the initial chest X-ray showed only slight bilateral pleural effusion, and cultures from ascites, stool, sputum, and pleural effusion were negative for Mycobacterium tuberculosis, CT scan of the lung showed a small consolidation shadow with contractile change, similar to tuberculosis. A few days after the CT scan of the lung, the sputum was positive for Mycobacterium tuberculosis. Finally we diagnosed active tuberculous peritonitis, and then started antituberculous therapy. In patients with massive ascites and fever of unknown origin, tuberculous peritonitis must be considered. Gallium-67 scintigraphy has been shown to be useful when there is a high index of suspicion of tuberculous peritonitis.     

血清-腹水白蛋白梯度和腹水ADA、CA125在结核性腹膜炎诊治中的临床价值

[目的]探讨血清-腹水白蛋白梯度(SAAG)和腹水腺苷脱氨酶(ADA)、CA125对结核性腹膜炎的临床诊断价值。[方法]选取132例腹水患者进行回顾性分析,并将其分为4组:单纯性结核性腹膜炎组(A组)75例,肝硬化合并结核性腹膜炎组(B组)14例,肝硬化组(C组)17例,其他原因腹水组(D组)26例。对所有患者同一天的血清白蛋白及腹水白蛋白浓度进行检测,计算出SAAG;并测定腹水中的ADA、CA125浓度。[结果]以SAAG11g/L为临界值,诊断结核性腹膜炎的敏感度为96.6%(86/89)、特异性为74.4%(32/43)、准确率为89.4%(118/132),A、B组SAAG浓度显著低于C、D组(P0.05),A、B组间比较差异无统计学意义(P0.05);以ADA40U/L为临界值,诊断结核性腹膜炎的敏感性为92.1%(82/89)、特异性为97.7%(42/43)、准确率为93.9%(124/132),A、B组腹水ADA浓度与C、D组比较,差异有统计学意义(P0.05),A、B组间比较差异无统计学意义(P0.05),A、B组抗结核治疗前后腹水ADA浓度比较差异有统计学意义(P0.05);以CA12535U/ml为临界值,诊断结核性腹膜炎的敏感性为100%(89/89)、特异性为34.9%(15/43)、准确性为78.8%(104/132),各组腹水CA125浓度比较均差异无统计学意义(P0.05),A、B组抗结核治疗前后腹水CA125浓度比较差异有统计学意义(P0.05)。[结论]腹水ADA诊断结核性腹膜炎的敏感性、特异性、准确性均较高,并可作为判断结核性腹膜炎抗结核治疗疗效的观察指标;SAAG诊断结核性腹膜炎的敏感性较高,但特异性较低;腹水CA125对结核性腹膜炎无诊断价值,但可作为治疗疗效追踪的观察指标。