自发性细菌性腹膜炎诊断和治疗现状

黎倍伶; 钟国涛; 陈金军

doi:10.3969/j.issn.1001-5256.2019.09.043

自发性细菌性腹膜炎诊断和治疗现状

DOI: 10.3969/j.issn.1001-5256.2019.09.043

南方医科大学南方医院肝病中心

基金项目:

科技部病毒性肝炎及艾滋病等传染病重大专项(2018ZX10723203)；国家自然科学基金(81270533,81470038)；国家重点研发计划(2017YFC0908100)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-05-10
- 出版日期: 2019-09-20

Current status of the diagnose and treatment of spontaneous bacterial peritonitis

Liver Disease Center, Nanfang Hospital, Southern Medical University

Research funding:

摘要

摘要: 感染是肝硬化患者的常见并发症,而自发性细菌性腹膜炎(SBP)为最常见的感染类型。总结基于腹水多核细胞数大于250/μl的SBP诊断标准形成过程、腹水细胞计数的局限性和SBP的治疗现状。提示目前SBP的诊断需要新的灵敏检测标志物,用于指导临床经验性抗菌治疗,从而优化SBP患者管理。
- 腹膜炎 /
- 肝硬化 /
- 诊断
Abstract: Infection is a common complication in patients with liver cirrhosis, and spontaneous bacterial peritonitis ( SBP) is the most common type of infection. This article summarizes the formation process of the diagnostic criteria of SBP based on a number of multinuclear cells of > 250 cells/μl in ascites, limitations of ascites cell counting, and the current status of the treatment of SBP. It is pointed out that novel biomarkers with high sensitivity are needed for the diagnosis of SBP diagnose, in order to guide empirical antimicrobial treatment and optimize the management of patients with SBP in clinical practice.
- peritonitis /
- liver cirrhosis /
- diagnosis

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参考文献(24)

[1]PIANO S, BROCCA A, MARESO S, et al.Infections complicating cirrhosis[J].Liver Int, 2018, 38 (Suppl 1) :126-133.

[2]MCKE MM, RUMYANTSEVA T, MCKE VT, et al.Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality[J].Liver Int, 2018, 38 (4) :645-653.

[3]PIANO S, BARTOLETTI M, TONON M, et al.Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections[J].Gut, 2018, 67 (10) :1892-1899.

[4]GUNNARSDOTTIR SA, SADIK R, SHEV S, et al.Small intestinal motility disturbances and bacterial overgrowth in patients with liver cirrhosis and portal hypertension[J].Am J Gastroenterol, 2003, 98 (6) :1362-1370.

[5]Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol, 2017, 33 (10) :1847-1863. (in Chinese) 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志, 2017, 33 (10) :1847-1863.

[6]NOBLE CA, PERRY IH, MARQUIS HH.Hepatic cirrhosis with encapsulated peritonitis:Report of case[J].Cal West Med, 1936, 45 (2) :172-174.

[7]KLINE MM, MCCALLUM RW, GUTH PH.The clinical value of ascitic fluid culture and leukocyte count studies in alcoholic cirrhosis[J].Gastroenterology, 1976, 70 (3) :408-412.

[8]JONES SR.The absolute granulocyte count in ascites fluid.An aid to the diagnosis of spontaneous bacterial peritonitis[J].West J Med, 1977, 126 (5) :344-346.

[9]HOEFS JC, CANAWATI HN, SAPICO FL, et al.Spontaneous bacterial peritonitis[J].Hepatology, 1982, 2 (4) :399-407.

[10]HOEFS JC, RUNYON BA.Spontaneous bacterial peritonitis[J].Dis Mon, 1985, 31 (9) :1-48.

[11]ALBILLOS A, CUERVAS-MONS V, MILLN I, et al.Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis[J].Gastroenterology, 1990, 98 (1) :134.

[12]SORT P, NAVASA M, ARROYO V, et al.Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J].N Engl JMed, 1999, 341 (6) :403-409.

[13]RIMOLA A, GARCIA-TSAO G, NAVASA M, et al.Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis:A consensus document.International Ascites Club[J].JHepatol, 2000, 32 (1) :142-153.

[14]LE S, SPELMAN T, CHONG CP, et al.Could adherence to quality of care indicators for hospitalized patients with cirrhosis-related ascites improve clinical outcomes?[J].Am J Gastroenterol, 2016, 111 (1) :87-92.

[15]NING NZ, LI T, ZHANG JL, et al.Clinical and bacteriological features and prognosis of ascitic fluid infection in Chinese patients with cirrhosis[J].BMC Infect Dis, 2018, 18 (1) :253.

[16]ICHOU L, CARBONELL N, RAUTOU PE, et al.Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis[J].Gut, 2016, 65 (3) :536-538.

[17]CULLARO G, KIM G, PEREIRA MR, et al.Ascites neutrophil gelatinase-associated lipocalin identifies spontaneous bacterial peritonitis and predicts mortality in hospitalized patients with cirrhosis[J].Dig Dis Sci, 2017, 62 (12) :3487-3494.

[18]TANG NY, CHEN WQ.Significance of lipopolysaccharide binding protein in serum and ascites of patients with hepatic cirrhosis complicated with spontaneous bacterial peritonitis[J].Chin JHepatol, 2012, 20 (7) :492-496. (in Chinese) 唐能源, 陈伟庆.血清及腹水脂多糖结合蛋白检测在肝硬化自发性细菌性腹膜炎诊断中的意义[J].中华肝脏病杂志, 2012, 20 (7) :492-496.

[19]BRUNS T, REUKEN PA, STENGEL S, et al.The prognostic significance of bacterial DNA in patients with decompensated cirrhosis and suspected infection[J].Liver Int, 2016, 36 (8) :1133-1142.

[20]DEVANI K, CHARILAOU P, JAISWAL P, et al.Trends in hospitalization, acute kidney injury, and mortality in patients with spontaneous bacterial peritonitis[J].J Clin Gastroenterol, 2019, 53 (2) :e68-e74.

[21]FERNNDEZ J, NAVASA M, PLANAS R, et al.Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis[J].Gastroenterology, 2007, 133 (3) :818-824.

[22]LOOMBA R, WESLEY R, BAIN A, et al.Role of fluoroquinolones in the primary prophylaxis of spontaneous bacterial peritonitis:Meta-analysis[J].Clin Gastroenterol Hepatol, 2009, 7 (4) :487-493.

[23]MIN YW, LIM KS, MIN BH, et al.Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites:A propensity scores matched cohort study[J].Aliment Pharmacol Ther, 2014, 40 (6) :695-704.

[24]PANDE C, KUMAR A, SARIN SK.Addition of probiotics to norfloxacin does not improve efficacy in the prevention of spontaneous bacterial peritonitis[J].Eur J Gastroenterol Hepatol, 2012, 24 (7) :831-839.

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