Chu C M, Chiu K W, Liaw Y F
Liver Unit, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Hepatology. 1992 May;15(5):799-803. doi: 10.1002/hep.1840150509.
The prevalence and prognostic significance of spontaneous bacterial peritonitis were prospectively studied in a series of 82 acute hepatitis patients decompensated with ascites. The in-hospital prevalence of spontaneous bacterial peritonitis was 31.7% (26 of 82 patients). Twenty cases were culture positive, including one with multiple isolates, and six cases were culture negative. E. coli and Klebsiella pneumoniae were the most common pathogens, accounting for 71.4% (15 of 21) of the total isolates, whereas only 9.5% were gram-positive organisms. No significant difference in the age, sex, cause of acute hepatitis, liver biochemistry, prothrombin time and ascites fluid concentration of total protein was noted between patients with spontaneous bacterial peritonitis and those without spontaneous bacterial peritonitis, except that bacteremia was recognized significantly more frequently in the former (57.7% or 15 of 26 patients) than in the latter (25.0% or 14 of 56 patients, p less than 0.005). In addition, patients with spontaneous bacterial peritonitis, when compared with those without spontaneous bacterial peritonitis, were more likely to have kidney failure (57.7% vs. 30.4%, p less than 0.05) and had a significantly higher mortality rate (73.1% vs. 39.3%, p less than 0.01). Among patients without spontaneous bacterial peritonitis, the prevalence of kidney failure and gastrointestinal hemorrhage and the mortality rate in patients with bacteremia (57.1%, 64.3% and 71.4%, respectively) were significantly higher than in those without bacteremia (21.4%, 19.0% and 28.6%, respectively; p less than 0.05, p less than 0.01 and p less than 0.01, respectively). In conclusion, 31.7% of severe acute hepatitis patients with ascites were recognized as having spontaneous bacterial peritonitis; the other 17.1% had bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
对82例因腹水导致失代偿的急性肝炎患者进行前瞻性研究，以探讨自发性细菌性腹膜炎的患病率及其预后意义。自发性细菌性腹膜炎的院内患病率为31.7%（82例患者中有26例）。20例培养阳性，其中1例有多种分离菌，6例培养阴性。大肠杆菌和肺炎克雷伯菌是最常见的病原体，占分离菌总数的71.4%（21例中的15例），而革兰氏阳性菌仅占9.5%。自发性细菌性腹膜炎患者与非自发性细菌性腹膜炎患者在年龄、性别、急性肝炎病因、肝脏生化指标、凝血酶原时间及腹水总蛋白浓度方面无显著差异，但前者菌血症的发生率（57.7%，即26例中的15例）显著高于后者（25.0%，即56例中的14例，p<0.005）。此外，与非自发性细菌性腹膜炎患者相比，自发性细菌性腹膜炎患者更易发生肾衰竭（57.7%对30.4%，p<0.05），死亡率也显著更高（73.1%对39.3%，p<0.01）。在非自发性细菌性腹膜炎患者中，菌血症患者的肾衰竭、胃肠道出血患病率及死亡率（分别为57.1%、64.3%和71.4%）显著高于无菌血症患者（分别为21.4%、19.0%和28.6%；p<0.05、p<0.01和p<0.01）。总之，31.7%的重度急性肝炎腹水患者被诊断为自发性细菌性腹膜炎；另外17.1%有菌血症。（摘要截选至250字）
