自发性腹膜炎被认为是严重影响肝硬化患者生存率的因素。然而，影响自发性腹膜炎患者生存率的因素需要被澄清。本研究对95例伴有SBP的肝硬化患者的血清和腹水的实验室检查结果和他们的腹腔液中分离出的微生物的特性进行了分析。培养阳性的SBP患者的比例为41.1%，从腹水中分离出47种菌株。细菌培养比率，革兰氏阴性和革兰氏阳性率分别为57.4%和40.4%的。大肠杆菌，肺炎克雷伯菌和链球菌的比例，分别为25.5%，19.1%，和19.1%。肠球菌占微生物的培养的12.8%。整体存活率在6，12，和24个月分别为44.5%，37.4%，和32.2%。细菌因素与SBP患者的生存率之间没有任何关系。多变量分析显示，肝细胞癌（HCC的存在；P = 0.001），高血清胆红素水平（≥3毫克/分升，P = 0.002），血清凝血酶原时间延长（即，国际标准化比值＞2.3，P＜0.001），肾功能损害（肌酐＞1.3毫克/分升，P＜0.001），并在腹水葡萄糖水平较低（低于50毫克/分升，P＜0.001）是总生存率的独立预测因素。肝癌，高血清胆红素水平，血清凝血酶原时间延长，肾功能不全，腹水葡萄糖水平低和伴有SPB的肝硬化患者高死亡率相关。
吉林大学第一医院肝病科 孙晶 摘译
本文首次发表于[Clin Mol Hepatol,2013,19(2):131-9]
Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis.
Abstract
BACKGROUND/AIMS:
Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified.
METHODS:
This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed.
RESULTS:
The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (≥3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictivefactors of overall survival rate.
CONCLUSIONS:
HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.
