Mohan Pazhanivel, Venkataraman Jayanthi
Department of Gastroenterology, Stanley Medical College, Old Jail Road, Royapuram, Chennai, Tamil Nadu 600 001, India.
Indian J Gastroenterol. 2011 Sep;30(5):221-4. doi: 10.1007/s12664-011-0131-7. Epub 2011 Sep 29.
Spontaneous bacterial peritonitis (SBP) has been typically described in hospitalized patients. There are little data on ascitic fluid infection in asymptomatic outpatients. The present study was aimed at determining the prevalence and risk factors for asymptomatic ascitic fluid infection among patients with liver cirrhosis attending an outpatient clinic.
Between January 2008 and December 2009, consecutive patients with cirrhosis (n = 110) undergoing therapeutic paracentesis in an outpatient setting were studied. Patients with fever, abdominal pain, hepatic encephalopathy, recent gastrointestinal bleeding, impaired renal function, previous history of SBP and on antibiotic treatment were excluded. Baseline demographic details, and etiology and severity of liver disease were recorded. Ascitic fluid cell count, culture and biochemical tests were done using standard laboratory techniques.
The causes of cirrhosis were alcohol (55.5%), hepatitis B (21.8%), hepatitis C (9.1%) and others (13.6%). A total of 278 paracenteses were done in them (average 2.5 [1.1] times per patient). Spontaneous ascitic fluid infection was found in 7 (2.5%) paracentesis, including spontaneous bacterial peritonitis in one (0.4%), monomicrobial nonneutrocytic bacterascites (MNB) in two (0.7%) and culture-negative neutrocytic ascites (CNNA) in four (1.4%). Escherichia coli, Klebsiella spp. and Staphylococcus aureus were grown. There was no difference between cirrhotic outpatients with and without infection in age, gender, alcohol consumption, etiology of cirrhosis, Child-Pugh score, serum albumin and ascitic fluid total protein. There was no death due to spontaneous ascitic fluid infection.
Asymptomatic ascitic fluid infection was very infrequent in patients with cirrhosis attending an outpatient clinic and undergoing therapeutic paracentesis.
自发性细菌性腹膜炎（SBP）通常在住院患者中被描述。关于无症状门诊患者腹水感染的数据很少。本研究旨在确定门诊肝硬化患者中无症状腹水感染的患病率及危险因素。
2008年1月至2009年12月，对在门诊接受治疗性腹腔穿刺术的连续肝硬化患者（n = 110）进行研究。排除有发热、腹痛、肝性脑病、近期胃肠道出血、肾功能损害、既往SBP病史及正在接受抗生素治疗的患者。记录基线人口统计学细节、肝病病因及严重程度。采用标准实验室技术进行腹水细胞计数、培养及生化检测。
肝硬化的病因包括酒精性（55.5%）、乙型肝炎（21.8%）、丙型肝炎（9.1%）及其他（13.6%）。共对他们进行了278次腹腔穿刺术（平均每位患者2.5 [1.1]次）。在7次（2.5%）腹腔穿刺术中发现自发性腹水感染，其中包括1例（0.4%）自发性细菌性腹膜炎、2例（0.7%）单一微生物非中性粒细胞性腹水（MNB）及4例（1.4%）培养阴性中性粒细胞性腹水（CNNA）。培养出大肠埃希菌、克雷伯菌属和金黄色葡萄球菌。有感染和无感染的肝硬化门诊患者在年龄、性别、酒精摄入量、肝硬化病因、Child-Pugh评分、血清白蛋白及腹水总蛋白方面无差异。无因自发性腹水感染导致的死亡。
在门诊接受治疗性腹腔穿刺术的肝硬化患者中，无症状腹水感染非常少见。
