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目的 :分析结核性腹膜炎的临床特点和诊断方法。方法 :回顾性分析近 5年间我院住院的成年人结核性腹膜炎病人的资料。结果 :主要症状为腹痛、腹胀、发热、腹水。具备典型结核毒性症状者 <5 0 % ,仅 2 0 %合并腹腔外结核病灶。实验室检查中 ,大多ESR增高 ,腹水ADA诊断结核性渗出液 ,其特异性可达 80 %以上。但血清或腹水的PPD -IgG、IgM和结明试验阳性率仅为在 5 0 %左右 ,而腹水涂片找抗酸杆菌阳性率为零。血性腹水 ,肝、脾增大 ,腹块或急性肠梗阻为主要表现者易被误诊。结论 :诊断主要依据临床症状符合 ,渗出性腹水和抗痨治疗有效。结核中毒症状、腹腔外结核证据、PPD -IgG、IgM或结明试验阳性等均不能作为本病诊断的必备条件。对不典型的病例在找不到其它疾病证据的前提下应尽早诊断性抗痨治疗。
Objective: To analyze the clinical features and diagnosis of tuberculous peritonitis. Methods: The data of adult tuberculous peritonitis patients hospitalized in our hospital during the past 5 years were retrospectively analyzed. Results: The main symptoms were abdominal pain, bloating, fever and ascites. Patients with typical symptoms of tuberculosis <50%, only 20% with extra-tuberculosis. Laboratory tests, mostly elevated ESR, ascites ADA diagnosis of tuberculous exudate, the specificity of up to 80%. However, the serum or ascites PPD-IgG, IgM and test results showed that the positive rate of only about 50%, while looking for ascites smear smear-positive rate of zero. Bloody ascites, liver, spleen increased, abdominal block or acute intestinal obstruction as the main manifestation of easily misdiagnosed. Conclusion: The diagnosis is mainly based on clinical symptoms, exudative ascites and anti-tuberculosis treatment is effective. Tuberculosis poisoning symptoms, extra-abdominal tuberculosis evidence, PPD-IgG, IgM or positive test results can not be used as a prerequisite for the diagnosis of this disease. For atypical cases in the absence of evidence of other diseases on the premise should be as soon as possible diagnostic anti-tuberculosis treatment.