Runyon B A
Department of Medicine, University of New Mexico School of Medicine, Albuquerque 87131.
Hepatology. 1990 Oct;12(4 Pt 1):710-5. doi: 10.1002/hep.1840120415.
Spontaneous bacterial peritonitis is diagnosed when (a) the ascitic fluid culture is positive, (b) the ascitic fluid neutrophil count is greater than or equal to 250 cells/mm3 and (c) there is no evident intraabdominal surgically treatable source for infection. Few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria (pure growth of a single type of organism), but the neutrophil count is less than 250 cells/mm3. In this prospective study of 138 episodes of culture-positive spontaneously infected ascites detected in 105 patients, 44 (31.9%) were episodes of "monomicrobial nonneutrocytic bacterascites" compared with 94 (68.1%) episodes of spontaneous bacterial peritonitis. Seventeen patients had both types of infection. The infection-related mortality and hospitalization mortality were similar between the two groups. Patients with bacterascites appeared to have less severe liver disease. In 62% of bacterascites episodes in which a second paracentesis was performed before any treatment the fluid spontaneously became sterile without development of ascitic fluid neutrocytosis. Thirty-eight percent of patients with bacterascites (who underwent a second paracentesis before treatment was started) progressed to spontaneous bacterial peritonitis--sometimes within a few hours. The concentration of the chemoattractant C5a was not decreased in the ascitic fluid of the bacterascites patients; this excludes ascitic fluid C5a deficiency as the explanation of the lack of neutrocytosis. Monomicrobial nonneutrocytic bacterascites is a common variant of ascitic fluid infection that may resolve without treatment or may progress to spontaneous bacterial peritonitis.
（a）腹水培养阳性；（b）腹水中性粒细胞计数大于或等于250个细胞/mm³；（c）无明显的可通过手术治疗的腹腔内感染源。关于腹水感染的一种变体，即培养出细菌（单一类型微生物的纯培养物）但中性粒细胞计数低于250个细胞/mm³的情况，目前可用的细节很少。在这项对105例患者中检测到的138例培养阳性的自发性感染腹水病例的前瞻性研究中，44例（31.9%）为“单微生物非中性粒细胞性细菌性腹水”，而自发性细菌性腹膜炎病例有94例（68.1%）。17例患者同时患有这两种感染。两组的感染相关死亡率和住院死亡率相似。患有细菌性腹水的患者似乎肝病较轻。在62%的细菌性腹水病例中，在未进行任何治疗前进行第二次腹腔穿刺时，腹水自发变为无菌，且未出现腹水中性粒细胞增多。38%的细菌性腹水患者（在开始治疗前接受了第二次腹腔穿刺）进展为自发性细菌性腹膜炎，有时在数小时内就会发生。细菌性腹水患者腹水中趋化因子C5a的浓度并未降低；这排除了腹水C5a缺乏作为缺乏中性粒细胞增多的原因。单微生物非中性粒细胞性细菌性腹水是腹水感染的一种常见变体，可能无需治疗即可缓解，也可能进展为自发性细菌性腹膜炎。
