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目的分析结核性腹膜炎(TBP)的临床特点,探讨其诊疗过程。方法选取2010年8月—2013年10月天津市海河医院确诊的TBP患者为研究对象,对其临床表现、实验室、影像学等情况进行回顾性分析。结果共计108例TBP患者,多伴有其他脏器结核,以肺结核为主,占22.22%(24/108);男女比例为1∶1.7;平均年龄为(36.49±18.76)岁。临床以发热、腹痛、腹胀为主,分别占75%、70.4%和67.6%;腹部有柔韧感者占51%。T细胞斑点试验(T-SPOT)检查阳性率为66.67%,血清结合抗体和结核菌素试验(TB-Ab和PPD)检查阳性率分别为33.33%和36.84%,差异有统计学意义(P<0.05);腹水腺苷脱氨酶(ADA)阳性率为72.72%,高于腹水PCR检查阳性率(23.53%),差异有统计学意义(P<0.05);腹部CT以大网膜及腹膜增厚80%(48/60)为主要表现。正规的抗结核治疗,血沉和癌抗原125(CA125)指标会有明显的下降。结论腹部CT对识别大网膜及腹膜增厚有意义;腹腔镜获得组织病理诊断TBP最可靠,血沉及CA125可作为治疗疗效评价指标。
Objective To analyze the clinical features of tuberculous peritonitis (TBP) and to discuss its diagnosis and treatment. Methods The TBP patients diagnosed in Haihe Hospital of Tianjin from August 2010 to October 2013 were selected as the research objects, and their clinical manifestations, laboratory and imaging were retrospectively analyzed. Results A total of 108 patients with TBP were found to be associated with tuberculosis in other organs, accounting for 22.22% (24/108). The ratio of male to female was 1: 1.7. The mean age was (36.49 ± 18.76) years old. Clinical fever, abdominal pain, abdominal distension, respectively, accounting for 75%, 70.4% and 67.6%; abdomen with flexible feeling accounted for 51%. The positive rate of T-SPOT was 66.67%, and the positive rates of serum antibody and tuberculin test (TB-Ab and PPD) were 33.33% and 36.84%, respectively, with significant difference (P < 0.05). The positive rate of adenosine deaminase (ADA) in ascites was 72.72%, higher than the positive rate of PCR in ascites (23.53%), the difference was statistically significant (P <0.05) Thick 80% (48/60) as the main performance. Formal anti-TB treatment, ESR and CA125 indicators will be significantly reduced. Conclusion Abdominal CT is of great significance in identifying the omentum and peritoneal thickening. Laparoscopy is the most reliable method to diagnose the pathological changes of TBP. ESR and CA125 can be used as evaluation indexes of curative effect.