el-Touny M, Osman L, Abd-el Hamid T, Sabbour M S
Department of Medicine, Ain Shams University, Cairo, Egypt.
J Trop Med Hyg. 1989 Feb;92(1):6-9.
In view of high mortality, variable clinical presentation, and late results of bacterial culture, early diagnosis of SBP and treatment are based on indirect parameters of infection. Forty-two patients with ascites and liver cirrhosis were studied. Ascitic fluid (AF) was examined for total protein content, pH, lactate dehydrogenase, amylase, absolute polymorphonuclear cell count (PMN) and for presence of bacteria by examining a fresh smear of the deposit and culture of the fluid under aerobic and anaerobic conditions. AF/serum gradient of total proteins and LDH was calculated. One patient proved to have a malignant ascites and was excluded. The remaining 41 patients fell into two groups: Group I PMN less than 250 cell mm-3, culture negative, sterile ascites, 36 patients. Group II PMN greater than 250 cell mm-3. (a) Culture positive neutrophilic ascites (SBP), three patients. (b) Culture negative neutrophilic ascites (CNNA), two patients. In both CNNA and SBP:AF/serum total LDH gradient greater than 0.75 In the sterile group: AF/serum total LDH gradient less than 0.58 There was no correlation between presence of infection and ascitic fluid pH, protein content and AF/serum total protein gradient. Therefore AF PMN greater than 250 mm and AF/serum total LDH gradient greater than 0.6 should be considered reliable, indirect parameters of infection, and CNNA a variant of SBP with a small bacterial inoculum size.
鉴于自发性细菌性腹膜炎（SBP）的高死亡率、临床表现多样以及细菌培养的滞后结果，SBP的早期诊断和治疗基于感染的间接参数。对42例腹水和肝硬化患者进行了研究。检测腹水（AF）的总蛋白含量、pH值、乳酸脱氢酶、淀粉酶、绝对多形核细胞计数（PMN），并通过检查沉积物的新鲜涂片以及在需氧和厌氧条件下对腹水进行培养来检测细菌的存在。计算AF/血清总蛋白和乳酸脱氢酶梯度。1例患者被证实为恶性腹水，被排除在外。其余41例患者分为两组：第一组PMN小于250个/mm³，培养阴性，无菌性腹水，36例患者。第二组PMN大于250个/mm³。（a）培养阳性的嗜中性腹水（SBP），3例患者。（b）培养阴性的嗜中性腹水（CNNA），2例患者。在CNNA和SBP中：AF/血清总乳酸脱氢酶梯度大于0.75。在无菌组中：AF/血清总乳酸脱氢酶梯度小于0.58。感染的存在与腹水pH值、蛋白含量以及AF/血清总蛋白梯度之间无相关性。因此，AF中PMN大于250/mm³以及AF/血清总乳酸脱氢酶梯度大于0.6应被视为可靠的感染间接参数，且CNNA是一种细菌接种量小的SBP变体。
