al Amri S M, Allam A R, al Mofleh I A
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Gastroenterol Hepatol. 1994 Sep-Oct;9(5):433-6. doi: 10.1111/j.1440-1746.1994.tb01269.x.
Medical records of 18 patients with spontaneous bacterial peritonitis (SBP) and 19 patients with culture negative neutrocytic ascites (CNNA) were reviewed. The diagnosis of SBP was based on a positive ascitic fluid culture, a polymorphonuclear cell count (PMN) greater than 250 cells/mm3 and the absence of an intra-abdominal source of infection. The diagnosis of CNNA was based on a PMN count greater than 250 cells/mm3, a negative ascitic fluid culture, the absence of an intra-abdominal source of infection and no antibiotic treatment in the preceding 30 days. All patients in both groups had liver cirrhosis, which was mainly (62.2%) due to HBV infection. A single strain, mostly 'a Gram-negative' bacillus, was recovered from the ascitic fluid culture in the vast majority of patients (83%) with SBP. There were no significant differences between the clinical data of both groups. However, the CNNA group had a significantly better Pugh score (P value = 0.01) with a mean score of 9.42 +/- 2.24, compared to the SBP group (10.94 +/- 2.88). The only significant difference in the laboratory data was that the total bilirubin was higher in the SBP group (P < 0.01). Hospital mortality was significantly higher in the SBP patients compared to those with CNNA, 50 and 16%, respectively (P < 0.03). Recurrent ascitic fluid infection occurred in one of five patients who initially presented. In contrast no recurrence was documented in 12 patients with CNNA. Spontaneous bacterial peritonitis is a serious complication of liver cirrhosis with significantly higher mortality than CNNA. A single organism, usually enteric, is the most common causative agent.
回顾了18例自发性细菌性腹膜炎（SBP）患者和19例培养阴性中性粒细胞性腹水（CNNA）患者的病历。SBP的诊断基于腹水培养阳性、多形核细胞计数（PMN）大于250个细胞/mm³以及无腹腔内感染源。CNNA的诊断基于PMN计数大于250个细胞/mm³、腹水培养阴性、无腹腔内感染源且在之前30天内未接受抗生素治疗。两组所有患者均患有肝硬化，主要（62.2%）由乙肝病毒感染引起。绝大多数（83%）SBP患者的腹水培养中分离出单一菌株，大多为“革兰氏阴性”杆菌。两组的临床数据无显著差异。然而，CNNA组的Pugh评分明显更好（P值 = 0.01），平均评分为9.42±2.24，而SBP组为（10.94±2.88）。实验室数据中唯一的显著差异是SBP组的总胆红素更高（P < 0.01）。SBP患者的医院死亡率明显高于CNNA患者，分别为50%和16%（P < 0.03）。最初就诊的5例患者中有1例发生复发性腹水感染。相比之下，12例CNNA患者未记录到复发情况。自发性细菌性腹膜炎是肝硬化的一种严重并发症，死亡率明显高于CNNA。单一微生物，通常是肠道微生物，是最常见的病原体。
