自发性细菌性腹膜炎患者的临床早期诊断及预后判定

目的总结分析肝硬化并发自发性细菌性腹膜炎(SBP)患者的临床和实验室检查特点,为临床早期诊治和判定预后提供依据。方法详细记录失代偿期肝硬化并发腹水患者临床表现,对每位患者依据临床及实验室检查结果进行Child Pugh分级,并进行腹水常规、生化、细菌培养及肿瘤细胞检测。结果110例患者中65例合并SBP,常见的临床表现有发热、腹胀、腹部压痛及反跳痛、腹泻、里急后重等。腹水WBC>0.5×109/L占45.3%,PMN>0.5占60.9%。腹水细菌培养阳性率10.8%,主要致病菌为大肠杆菌。主要死亡原因为原发病的并发症。Child Pugh分级C级、病毒重叠感染、低血钠水平等与高死亡率有关。结论失代偿期肝硬化并发自发性细菌性腹膜炎患者临床表现多样且不典型,早期诊断需结合临床表现及腹水检查结果综合判断;腹水细菌培养阳性率低;并发SBP患者的预后与原有肝病程度、病毒重叠感染等多种因素有关。

Early Diagnosis and Prognosis Prevision for Patients of Spontaneous Bacterial Peritonitis

Objective To summarize and analyze the clinical and laboratory characteristics of liver cirrhosis patients complitated with spontaneous bacterial peritonitis(SBP),which provide proof for early diagnosis and prognosis evaluation. Methods Clinical manifestation was recorded in detail in 110 cases of decompensatory liver cirrhosis patients complitated with SBP,and child-pugh classification was made according to the detection. Ascites routine and biochemical examination,bacterial culture and tumor cell detection in ascites were taken in each patient. Results 65 in 110 cases of patients were complitated with SBP,their common clinical manifestation included fever,abdominal distension,abdominal pain and rebound pain,diarrhea,and tenesmus ect. The WBC counts in ascites of 58 patients(45.3%) were more than 500/mm3,wheras the PMN counts of 78 patients(60.9%) were more than 500/mm3.The positive rate of bacterial culture of ascites was 10.8%. E. coli is the main pathogen. Complication of the primary disease is the main reason of death.Patients.Child Pugh C grade,virus superinfection and low serum sodium level were related to high mortality. Conclusion The clinical manifestation of SBP was various and atypical in some patients and could be concealed by the symptoms of the primary disease.Because bacteria culture of ascites has low positive rate,diagnosis simply by the culture result would delay the treatment of SBP. The prognosis of these patients is related to the degree of liver damage,whether superinfection of virus exist,the level of serum sodium and protein content of ascite,act. The main reason of death is complication of primary disease.