Ljubicic N, Spajic D, Vrkljan M M, Altabas V, Doko M, Zovak M, Gacina P, Mihatov S
Department of Medicine, Sestre milosrdnice Clinical Hospital, Zagreb, Croatia.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1360-3.
BACKGROUND/AIMS: Spontaneous bacterial peritonitis is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. The aim of this study was to demonstrate whether it is possible, on the basis of ascitic fluid polymorphonuclear cell count in patients with liver cirrhosis and spontaneous bacterial peritonitis, to determine the optimal duration of cefotaxime therapy, as the most frequently applied empirical therapy, and possibly anticipate the disease recurrence.
In 16 patients with alcoholic liver cirrhosis and confirmed diagnosis of spontaneous bacterial peritonitis, cefotaxime therapy was administered 2g t.i.d. during 5 days. Before the therapy, at 48 hours, 5 days and 15-20 days after the cefotaxime therapy was started, in all patients with spontaneous bacterial peritonitis diagnostic abdominal paracentesis was performed, each time determining the ascitic fluid polymorphonuclear cell count together with microbiological analysis.
In the course of the "primary" spontaneous bacterial peritonitis attack, 3 patients died (18.8%). In 4 patients the recurrence of spontaneous bacterial peritonitis was observed within 15-20 days after therapy was discontinued. Two patients died during the therapy of spontaneous bacterial peritonitis recurrence. After 48 hours of therapy, 11 patients with the "primary" spontaneous bacterial peritonitis attack were without any symptoms (68.8%). Out of these 11, 10 patients (62.5%) had the ascitic fluid polymorphonuclear cell count lower than 250/mm3. After 5 days of therapy, 12 patients (75%) were free of symptoms, and the number of ascitic fluid polymorphonuclear cell count < 250/mm3 was still found in 10 (62.5%) patients. No association between the presence of symptoms 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis was established. A significant association was found between the ascitic fluid polymorphonuclear cell count determined 48 hours after the therapy and the recurrence of spontaneous bacterial peritonitis. A recurrence occurred in only 1 patient with the number of ascitic fluid polymorphonuclear cell count < 250/mm3, 48 hours after the therapy was started. A recurrence of spontaneous bacterial peritonitis occurred in all the patients who had an ascitic fluid PMN cell count > or = 250/mm3, 48 hours after the therapy was started.
By monitoring the ascitic fluid PMN cell count it seems to be possible to determine the efficacy and optimal duration of cefotaxime therapy in patients with spontaneous bacterial peritonitis when it is of most importance that the number of ascitic fluid PMN cell count should decrease below 250/mm3 during the therapy.
背景/目的：自发性细菌性腹膜炎是肝硬化腹水患者最常见的并发症之一。本研究的目的是基于肝硬化合并自发性细菌性腹膜炎患者腹水多形核细胞计数，确定头孢噻肟作为最常用的经验性治疗药物的最佳治疗时长，并预测疾病复发情况。
对16例酒精性肝硬化且确诊为自发性细菌性腹膜炎的患者，给予头孢噻肟2g，每日3次，共治疗5天。在治疗前、治疗开始后48小时、5天以及15 - 20天，对所有自发性细菌性腹膜炎患者进行诊断性腹腔穿刺，每次均测定腹水多形核细胞计数并进行微生物分析。
在“原发性”自发性细菌性腹膜炎发作过程中，3例患者死亡（18.8%）。4例患者在治疗停止后15 - 20天内出现自发性细菌性腹膜炎复发。2例患者在自发性细菌性腹膜炎复发治疗期间死亡。治疗48小时后，11例“原发性”自发性细菌性腹膜炎发作患者无症状（68.8%）。在这11例患者中，10例（62.5%）腹水多形核细胞计数低于250/mm³。治疗5天后，12例患者（75%）无症状，10例（62.5%）患者腹水多形核细胞计数仍<250/mm³。治疗后48小时的症状与自发性细菌性腹膜炎复发之间未发现关联。治疗后48小时测定的腹水多形核细胞计数与自发性细菌性腹膜炎复发之间存在显著关联。治疗开始后48小时，腹水多形核细胞计数<250/mm³的患者中仅1例复发。治疗开始后48小时，腹水PMN细胞计数≥250/mm³的所有患者均出现自发性细菌性腹膜炎复发。
通过监测腹水PMN细胞计数，似乎可以确定头孢噻肟治疗自发性细菌性腹膜炎患者的疗效和最佳时长，此时治疗期间腹水PMN细胞计数降至250/mm³以下最为重要。
