Wang S S, Tsai Y T, Lee S D, Chen H T, Lu C W, Lee F Y, Jeng J S, Liu Y C, Lo K J
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Gastroenterology. 1991 Dec;101(6):1656-62. doi: 10.1016/0016-5085(91)90405-a.
To delineate the natural clinical course of spontaneous bacterial peritonitis in hepatitis B-related cirrhosis and to determine if it occurs in hepatocellular carcinoma, a prospective survey was conducted in 262 patients over 2 1/2 years. The in-hospital incidence and mortality rates of spontaneous bacterial peritonitis were 21.6% and 36.4%, respectively, in cirrhosis and 7.3% and 50% in hepatocellular carcinoma. In cirrhosis, the cumulative probability of annual recurrence of spontaneous bacterial peritonitis was 47.3%, which was significantly higher than the annual probability of occurrence of 11.3% in those with no previous attack (P less than 0.0001). The cumulative probability of annual survival was 27.6% in the spontaneous bacterial peritonitis patients, significantly lower than the probability of 64.0% in the control group (P = 0.0001). A univariate analysis, with Kaplan-Meier curves compared by the Mantel-Cox test, and subsequent multivariate analysis by stepwise Cox regression procedure were used to evaluate 37 variables recorded immediately after admission. Blood urea nitrogen concentration greater than 10.5 mmol/L urea (greater than 30 mg/dL) and ascitic fluid protein concentration less than 7.35 g/L (less than 735 mg/dL) were found to be the only significant predictors of lower annual survival; ascitic fluid protein concentration less than 7.50 g/L (less than 750 mg/dL) was the only significant predictor of higher annual recurrence. The authors conclude that spontaneous bacterial peritonitis has a high risk of recurrence in hepatitis B-related cirrhosis and that the same disease occurring in patients with hepatocellular carcinoma is related to the underlying cirrhosis rather than the hepatocellular carcinoma.
为了描述乙型肝炎相关性肝硬化患者自发性细菌性腹膜炎的自然临床病程，并确定其是否在肝细胞癌患者中发生，我们对262例患者进行了为期两年半的前瞻性调查。肝硬化患者自发性细菌性腹膜炎的住院发病率和死亡率分别为21.6%和36.4%，肝细胞癌患者分别为7.3%和50%。在肝硬化患者中，自发性细菌性腹膜炎的年复发累积概率为47.3%，显著高于既往无发作患者的年发病概率11.3%（P<0.0001）。自发性细菌性腹膜炎患者的年生存累积概率为27.6%，显著低于对照组的64.0%（P=0.0001）。采用单因素分析（通过Mantel-Cox检验比较Kaplan-Meier曲线）以及随后通过逐步Cox回归程序进行多因素分析，以评估入院后立即记录的37个变量。发现血尿素氮浓度大于10.5 mmol/L尿素（大于30 mg/dL）和腹水蛋白浓度小于7.35 g/L（小于735 mg/dL）是年生存率较低的唯一显著预测因素；腹水蛋白浓度小于7.50 g/L（小于750 mg/dL）是年复发率较高的唯一显著预测因素。作者得出结论，自发性细菌性腹膜炎在乙型肝炎相关性肝硬化患者中有很高的复发风险，并且在肝细胞癌患者中发生的同一种疾病与潜在的肝硬化有关，而非与肝细胞癌有关。
