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目的探讨肝硬化腹水并发自发性细菌性腹膜炎(SBP)的临床特征及危险因素。方法回顾性分析85例肝硬化腹水并发SBP患者的临床资料,总结其临床表现、实验室检查特征及治疗转归情况,并对所有临床病理因素进行Logistic回归分析。结果本组患者主要临床表现为发热、腹胀和腹痛;血常规及腹水中的白细胞计数(WBC)均显著升高,中性粒细胞(PMN)比值>0.5者达83.53%;53例患者腹水细菌培养阳性(62.35%),4例真菌培养阳性(4.71%)。至2014年8月,35例(41.18%)SBP治愈或好转,50例(58.82%)无效或恶化。Logistic多元回归分析表明,腹水蛋白及消化道出血是肝硬化腹水并发SBP的独立影响因素。结论肝硬化腹水并发SBP主要临床表现为发热、腹胀和腹痛,血常规及腹水中的WBC均显著升高,治疗转归较差,腹水蛋白及消化道出血是其发病的独立危险因素。
Objective To investigate the clinical features and risk factors of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. Methods The clinical data of 85 patients with cirrhotic ascites complicated with SBP were retrospectively analyzed. The clinical manifestations, laboratory features and outcome of treatment were summarized. Logistic regression analysis was performed on all clinical and pathological factors. Results The main clinical manifestations of this group were fever, abdominal distension and abdominal pain. WBC in blood and ascites were significantly increased, with 83.53% of patients with neutrophil (PMN)> 0.5. 53 patients had ascites bacteria Positive culture (62.35%), 4 cases of fungal culture positive (4.71%). As of August 2014, 35 cases (41.18%) had SBP cured or improved, and 50 cases (58.82%) had no effect or worsened. Logistic multivariate regression analysis showed that ascites protein and gastrointestinal bleeding were the independent influencing factors of SBP in cirrhotic patients with ascites. Conclusions The main clinical manifestations of ascites associated with hepatic cirrhosis are fever, abdominal distension and abdominal pain. WBC in blood and ascites are significantly increased, and the treatment outcome is poor. Ascites protein and gastrointestinal bleeding are the independent risk factors.