慢性肝衰竭并发自发性细菌性腹膜炎诊断标准探讨  

Diagnostic criteria for spontaneous bacterial peritonitis in patients with chronic liver failure

作　　者：朱研[1] 张辉艳[1] 张长江[1] 毛青[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,重庆400038

出　　处：《第三军医大学学报》2011年第21期2227-2229,共3页Journal of Third Military Medical University

基　　金："十一五"国家科技重大专项(2008ZX10002-005)~~

摘　　要：目的探讨慢性肝衰竭并发自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的早期诊断标准。方法回顾性分析我科2008年1月至2011年5月住院的慢性肝衰竭患者1 003例,从中选取并发SBP者385例,其中腹水多形核白细胞(polymorphonuclear leucocyte,PMN)计数≥250×106/L者126例(A组),腹水白细胞(whiteblood cell,WBC)计数≥250×106/L但不足A组标准者105例(B组),腹水WBC计数<250×106/L但PMN比例≥50%者56例(C组),腹水WBC计数<250×106/L且PMN比例<50%者98例(D组)。对各组患者抗生素治疗前后腹水WBC或PMN计数以及4组患者预后等进行分析。结果治疗7 d后,A组71.4%(20/28)的患者腹水PMN计数低于250×106/L;B组患者腹水WBC计数较治疗前明显降低(P<0.05);C组及D组患者腹水WBC计数与治疗前相比差异不显著(P>0.05)。结论腹水WBC计数≥250×106/L作为SBP的诊断标准更为合理。对慢性肝衰竭并发SBP者,建议抗感染疗程在7 d以上。Objective To investigate the diagnostic criteria for spontaneous bacterial peritonitis（SBP） in patients with chronic liver failure.Methods A total of 1 003 inpatients with chronic liver failure in our department during 2008.01 to 2011.05 were enrolled.Retrospective data from clinical records of 385 consecutive episodes of SBP were chosen.One hundred twenty-six patients with ascitic fluid polymorphonuclear leucocyte（PMN） counts ≥250×10^6/L were assigned to group A;One hundred and five patients with ascitic fluid white blood cell（WBC） counts ≥250×10^6/L and PMN counts 250×10^6/L were assigned to group B;Fifty-six patients with ascitic fluid WBC counts 250×10^6/L and proportion of PMN in ascitic fluid≥50% were assigned to group C;the remaining 98 patients were assigned to group D.WBC or PMN counts in ascitic fluid before and after antibiotic treatment,and the prognosis of patients in the four groups were analyzed.Results After antibiotic treatment for 7 d,patients with ascitic fluid PMN counts less than 250×10^6/L accounted for 71.4%（20/28） in group A;the ascitic fluid WBC counts of group B was significantly lower than those before treatment（P〈0.05）,but the ascitic fluid WBC counts of group C and group D were not significantly different from those before treatment（P〈0.05）.Conclusions Ascitic fluid WBC count≥250×10^6/L is a more reasonable criterion and is important for diagnosis of SBP.It is recommended to extend the course of antibiotic treatment（more than 7 d） for SBP in patients with chronic liver failure.

关 键 词：肝衰竭 自发性细菌性腹膜炎 诊断标准 

分 类 号：R575.3[医药卫生—消化系统] R572.204[医药卫生—内科学]