Cadranel Jean-François, Nousbaum Jean-Baptiste, Bessaguet Christophe, Nahon Pierre, Nguyen-Khac Eric, Moreau Richard, Thévenot Thierry, Silvain Christine, Bureau Christophe, Nouel Olivier, Pilette Christophe, Paupard Thierry, Pauwels Arnaud, Sapey Thierry, Grangé Jean-Didier, Tran Albert
Jean-François Cadranel, Liver, Gastroenterology and Nutrition Department, Centre Hospitalier Laennec, 60100 Creil, France.
World J Hepatol. 2013 Mar 27;5(3):104-8. doi: 10.4254/wjh.v5.i3.104.
To compare the incidence of spontaneous bacterial peritonitis in cirrhotic outpatients and inpatients undergoing therapeutic paracentesis
From January 1 to May 31, 2004, 1041 patients from 70 different hospitals underwent 2123 therapeutic abdominal paracentesis (AP) performed as a outpatient procedure in 355 and as inpatient procedure in 686 cases respectively. The following parameters were compared prospectively between outpatients and inpatients: spontaneous bacterial peritonitis (SBP) prevalence, age, gender, cause of cirrhosis, symptoms, score and grade according to Child-Pugh classification, cirrhosis complications, antibiotics treatment, serum creatinine, platelet count and ascitic protein concentration.
SBP was observed in 91 patients. In the whole population the SBP prevalence was 8.7% (95%CI: 7.2-10.6) it was 11.7% (95%CI: 9.5-14.3) in inpatients and 3.1% (95%CI: 1.7-5.5) in outpatients (P < 0.00001). SBP prevalence was 8.3% (95%CI: 4.3-15.6) in symptomatic outpatients vs 1.2% (95%CI: 0.4-3.4) in asymptomatic outpatients (P < 0.002). Patients undergoing outpatient AP were significantly different from those undergoing inpatient AP; they were older (61.1 ± 11.1 years vs 59.4 ± 11.7 years; P = 0.028), cause of cirrhosis was less often alcohol (83 .7 vs 88.2%; P < 0.001), Child-Pugh score was lower (8.9 vs 10.1; P < 0.001) and more often B than C (63.7% vs 38%; P < 0.001). In addition, in outpatients the platelet count was higher (161 ± 93 Giga/L vs 143 ± 89 Giga/L; P = 0.003), serum total bilirubin concentration was lower (38.2 ± 60.7 μmol/L vs 96.3 ± 143.3 μmol/L; P < 0.0001), and ascitic protein concentration higher (17.9 ± 10.7 g/L vs 14.5 ± 10.9 g/L; P < 0.001) than in inpatients.
In asymptomatic cirrhotic outpatients, the incidence of spontaneous bacterial peritonitis is low thus exploratory paracentesis could be avoided in these patients without significant risk.
比较接受治疗性腹腔穿刺术的肝硬化门诊患者和住院患者自发性细菌性腹膜炎的发生率
2004年1月1日至5月31日，来自70家不同医院的1041例患者接受了2123次治疗性腹腔穿刺术（AP），其中355例为门诊手术，686例为住院手术。对门诊患者和住院患者的以下参数进行前瞻性比较：自发性细菌性腹膜炎（SBP）患病率、年龄、性别、肝硬化病因、症状、根据Child-Pugh分类的评分和分级、肝硬化并发症、抗生素治疗、血清肌酐、血小板计数和腹水蛋白浓度。
91例患者观察到SBP。在总体人群中，SBP患病率为8.7%（95%CI：7.2 - 10.6），住院患者中为11.7%（95%CI：9.5 - 14.3），门诊患者中为3.1%（95%CI：1.7 - 5.5）（P < 0.00001）。有症状的门诊患者中SBP患病率为8.3%（95%CI：4.3 - 15.6），无症状门诊患者中为1.2%（95%CI：0.4 - 3.4）（P < 0.002）。接受门诊AP的患者与接受住院AP的患者有显著差异；他们年龄更大（61.1 ± 11.1岁对59.4 ± 11.7岁；P = 0.028），肝硬化病因较少为酒精性（83.7对88.2%；P < 0.001），Child-Pugh评分较低（8.9对10.1；P < 0.001），且B级多于C级（63.7%对38%；P < 0.001）。此外，门诊患者的血小板计数更高（161 ± 93千兆/L对143 ± 89千兆/L；P = 0.003），血清总胆红素浓度更低（38.2 ± 60.7微摩尔/L对96.3 ± 143.3微摩尔/L；P < 0.0001），腹水蛋白浓度高于住院患者（17.9 ± 10.7克/L对14.5 ± 10.9克/L；P < 0.001）。
在无症状的肝硬化门诊患者中，自发性细菌性腹膜炎的发生率较低，因此在这些患者中可避免进行探查性腹腔穿刺术而无显著风险。
