Vieira Sandra M G, Matte Ursula, Kieling Carlos O, Barth Afonso L, Ferreira Cristina T, Souza Aline F, Taniguchi Adriano, da Silveira Themis R
Hospital de Clínicas de Porto Alegre, Brazil.
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):289-94. doi: 10.1097/01.mpg.0000154659.54735.1d.
To determine the prevalence of spontaneous bacterial peritonitis, ascites with bacterial infection and noninfected ascites in pediatric patients with portal hypertensive ascites and to compare the clinical and laboratory features of infected and noninfected ascites.
Forty-one episodes of portal hypertensive ascites (serum-ascites albumin gradient >1.1 g/dL) in 31 patients were studied. Median age was 2.9 years. Twenty-four (77.4%) patients were cirrhotic and 20 (83.3%) were classified as Child-Pugh C. Median pediatric end-stage liver disease score was 18.5. The following ascites features were assessed: polymorphonuclear neutrophil cell count, cytology, pH, concentration of glucose, lactic dehydrogenase, total protein and albumin, Gram stain and bacteriological culture. Blood was sampled for complete blood count, coagulation studies, liver and renal function tests. Groups were compared by Mann-Whitney and chi tests (P < 0.05).
Noninfected ascites were observed in 29 of 41 samples, spontaneous bacterial peritonitis in eight of 41 and ascites with bacterial infection in four of 41. The most prevalent clinical features were fever, voluminous ascites and encephalopathy, but there were no significant differences in the clinical features of the groups. All patients with infected ascites were cirrhotic. There was no statistical difference in Child-Pugh or pediatric end-stage liver disease status between patients with infected and noninfected ascites. Culture of ascetic fluid was positive in four of eight cases of spontaneous bacterial peritonitis. Gram-negative rods were the most prevalent bacteria cultured. Except for serum albumin, no statistical differences in biochemical markers were observed between patients with infected and noninfected ascites.
The prevalence of infected ascites was 29.2%. With the exception of serum albumin, there were no differences in the clinical and biochemical features of patients with infected ascites and noninfected ascites.
确定门静脉高压性腹水患儿自发性细菌性腹膜炎、腹水合并细菌感染及非感染性腹水的患病率，并比较感染性和非感染性腹水的临床及实验室特征。
对31例患者的41次门静脉高压性腹水发作（血清-腹水白蛋白梯度>1.1 g/dL）进行研究。中位年龄为2.9岁。24例（77.4%）患者为肝硬化，20例（83.3%）属于Child-Pugh C级。小儿终末期肝病评分中位数为18.5。评估以下腹水特征：多形核中性粒细胞计数、细胞学检查、pH值、葡萄糖浓度、乳酸脱氢酶、总蛋白和白蛋白、革兰氏染色及细菌培养。采集血液进行全血细胞计数、凝血研究、肝肾功能检查。采用Mann-Whitney检验和卡方检验对各组进行比较（P<0.05）。
41份样本中，29份为非感染性腹水，41份中有8份为自发性细菌性腹膜炎，41份中有4份为腹水合并细菌感染。最常见的临床特征为发热、大量腹水和脑病，但各组临床特征无显著差异。所有感染性腹水患者均为肝硬化。感染性和非感染性腹水患者的Child-Pugh或小儿终末期肝病状态无统计学差异。8例自发性细菌性腹膜炎患者中，4例腹水培养呈阳性。革兰氏阴性杆菌是培养出的最常见细菌。除血清白蛋白外，感染性和非感染性腹水患者的生化指标无统计学差异。
感染性腹水的患病率为29.2%。除血清白蛋白外，感染性腹水和非感染性腹水患者的临床及生化特征无差异。
