肝炎肝硬化合并自发性细菌性腹膜炎43例临床分析

自发性细菌性腹膜炎(spontaneous bacterial peritonitis，SBP)是肝炎肝硬化患者常见并发症，因其临床症状、体征不典型而容易误诊。作者对2000年～2002年本院收治的43例肝硬化合并SBP患者临床资料进行了回顾性分析，报告如下。     

Effects of glutamine supplementation on splenocyte cytokine mRNA expression in rats with septic peritonitis

AIM: To investigate the effects of glutamine (GLN)-enriched diets before and GLN-containing total parenteral nutrition (TPN) after sepsis or both on the secretion of cytokines and their mRNA expression levels in splenocytes of rats with septic peritonitis. METHODS: Rats were assigned to a control group and 4 experimental groups. The control group and experimental groups 1 and 2 were fed a semipurified diet, while experimental groups 3 and 4 had part of the casein replaced by GLN which provided 25% of the total nitrogen. After rats were fed with these diets for 10 d, sepsis was induced by cecal ligation and puncture (CLP), whereas the control group underwent a sham operation, at the same time, an internal jugular vein was cannulated. All rats were maintained on TPN for 3 d. The control group and experimental groups 1 and 3 were infused with conventional TPN, while the TPN in experimental groups 2 and 4 was supplemented with GLN, providing 25% of the total nitrogen in the TPN solution. All rats were kiued 3 d after sham operation or CLP to examine their splenocyte subpopulation distribution and cytokine expression levels. RESULTS: Most cytokines could not be detected in plasma except for IL-10. No difference in plasma IL-10 was observed among the 5 groups. The IL-2, IL-4, IL-10, and TNF-α mRNA expression levels in splenocytes were significantly higher in experimental groups 2 and 4 than in the control group and group 1. The mRNA expression of IFN-γ was significantly higher in the GLN-supplemented groups than in the control group and experimental group 1. The proportion of CD45Ra+ was increased, while those of CD3+ and CD4+ were decreased in experimental group 1 after CLP was performed. There were no differences in spleen CD3+ lymphocyte distributions between the control and GLN-supplemented groups. CONCLUSION: GLN supplementation can maintain T-lymphocyte populations in the spleen and significantly enhance the mRNA expression levels of Th1 and Th2 cytokines and TNF-αin the spleen of rats with septic peritonitis.     

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…     

重型肝炎

肠道选择性净化联合微生态制剂对重型肝炎自发性细菌性腹膜炎的预防效果；慢性重型肝炎并发自发性细菌性腹膜炎40例临床分析；低钠血症对慢性中、重度、重型肝炎预后的影响；苦参素联合促肝细胞生长素治疗急性乙型临界性重型肝炎的疗效观察；71例重型肝炎并原发性腹膜炎临床分析；重型肝炎并发多器官功能衰竭分析；膦甲酸钠治疗乙型重型肝炎38例。[编按]     

肝硬化并发自发性细菌性腹膜炎患者腹水病原菌及其耐药分析

自发性细菌性腹膜炎（SBP）是肝硬化常见的严重并发症，住院的肝硬化患者SBP发病率约为10%～30％，一旦发生，常使肝硬化病情加重，腹水难以消退，并促使肝肾综合征的发生，最终危及患者生命。因此，早期诊断和合理治疗至关重要。本研究对我院2005年6月-2007年6月住院的肝硬化并发SBP患者54例（腹水细菌培养均阳性）进行回顾性分析，探讨腹水病原菌的分布及其耐药情况，旨在为临床合理选用抗生素提供参考。     

失代偿性肝硬化合并自发性细菌性腹膜炎20例临床分析

自发性细菌性腹膜炎(SBP)指在已有腹水存在的基础上，腹腔内无明确感染灶或脏器破裂，也无直接污染途径而发生的腹膜细菌感染。常发生于失代偿期肝硬化或慢性重型肝炎合并腹水的患者，其发生率为10％～30％。本文就20例失代偿性肝硬化合并SBP患者的临床资料进行分析，旨在总结其临床特点，以求早期诊断，合理用药，减少危险因素。     

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy （Hartmann＇s procedure） were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.     

肠道功能的改变在自发性细菌性腹膜炎中的作用

自发性细菌性腹膜炎(Spontaneousbacterialperi tonitis ,SBP)是肝硬化患者腹水急性细菌感染,而无外源性或腹腔内感染的其他来源[1] 。临床上如肝硬化患者腹水中中性粒细胞≥2 5 0×10 6 /L ,腹水培养阳性且缺乏继发性腹膜炎的证据就可诊断为SBP。其发生率在肝硬化住院患者中为10 % - 2 6 % ,占肝硬化重症感染的6 0 % - 75 % [2 ] 。其发病机制尚未阐明,最近的研究显示肠道细菌是SBP感染的一个主要来源,胃肠道屏障的改变以及氧化反应产生的自由基可能在细菌易位至血循环和腹水中起着重要作用。1　肝硬化SBP患者胃肠道屏障功能的改变正…     

162例次腹膜透析相关性腹膜炎病原学分析

目的研究该院腹膜透析相关性腹膜炎透出液的病原菌培养鉴定结果、涂片革兰染色镜检结果、耐药情况,为腹膜透析相关性腹膜炎的临床诊断、治疗、预后及实验室检查提供数据支持。方法回顾性分析2014年1月至2019年4月该院收治的124例腹膜透析相关性腹膜炎患者共162次透出液的病原菌分布、涂片革兰染色镜检结果、耐药情况。结果 162例次透出液检测中,115例次透出液培养阳性,阳性率71.0%。培养出126株病原菌,其中83株革兰阳性球菌(65.9%),34株革兰阴性杆菌(27.0%),6株真菌(4.8%),2株革兰阴性球菌,1株革兰阳性杆菌。115例次透出液培养阳性的腹膜炎患者中有78例次同步送检涂片革兰染色,其中34例次阳性,阳性率43.6%。在病原菌耐药性方面,48.0%葡萄球菌耐苯唑西林,4.8%链球菌耐青霉素,54.5%肠杆菌目细菌耐第3、4代头孢菌素。结论在该院,腹膜透析相关性腹膜炎病原菌以革兰阳性球菌为主;在透析相关性腹膜炎诊治中,应重视透出液涂片革兰染色镜检;应根据病原菌监测情况进行经验性抗菌药物的选择。     

硬化性腹膜炎CT误诊1例

病例男,38岁。3年前无意中发现左下腹部有一鸡蛋大小的包块,无腹痛、腹胀、便血、腹泻等消化道症状,未予诊治。后自觉包块渐进性增大,来院就诊。体格检查:体温36.7℃,脉搏60次/min,呼吸19次/min,血压100/50mmHg,神志清楚,全身皮肤巩膜无黄染,浅表淋巴结未触及肿大,心肺未见异常。专科检查:腹平坦,未见胃肠型蠕动波,肝脾未触及,全腹柔软,左下腹可触及一大小约7.0cm×6.0cm×5.0cm的肿块,质硬,与周围边界尚清,活动度差,无明显压痛、反跳痛