Lee M Y, Wang S S, Lu C W, Chao Y, Lee F Y, Wu S L, Lee S D, Tsai Y T, Lo K J
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Feb;53(2):71-6.
The clinical value of ascitic fluid pH or lactate in the diagnosis of spontaneous bacterial peritonitis was debated in alcoholic cirrhosis. It was rarely discussed in hepatitis B-related cirrhosis. We investigated the best rapid diagnostic method in spontaneous bacterial peritonitis of patients with hepatitis B-related cirrhosis.
Ascitic fluid polymorphonuclear cell count, ascitic fluid pH, arterial-ascitic fluid pH gradient, ascitic fluid lactate, and arterial-ascitic fluid lactate gradient were analyzed in 79 patients with sterile portal hypertension-related ascites, 31 patients with spontaneous bacterial peritonitis, 16 patients with hepatocellular carcinoma, 15 patients with malignancy-related ascites and 9 patients with other miscellaneous diseases.
The sensitivity, specificity and accuracy of the diagnosis of spontaneous bacterial peritonitis were 100, 94 and 95% with the cut-off value of an ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3, and were 86, 98 and 96% with that value > or = 500 cells/mm3, respectively. The sensitivity, specificity and accuracy were 29, 92, 80% using ascitic fluid pH < or = 7.35 as a cut-off value; 38, 91, 82% using arterial-ascitic fluid pH gradient > or = 0.1 as a cut-off value; 52, 92, 85% using ascitic fluid lactate > or = 32 mg/dL as a cut-off value, and 38, 96, 85% using arterial-ascitic fluid lactate gradient > or = 20 mg/dL as a cut-off value.
The sensitivity of ascitic fluid pH or lactate was too low to aid in a diagnosis of spontaneous bacterial peritonitis in hepatitis B-related cirrhosis in spite of the acceptable specificity. An ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3 or > or = 500 cells/mm3 was the major and appropriate aids in the rapid diagnosis of spontaneous bacterial peritonitis.
酒精性肝硬化患者腹水中pH值或乳酸水平在自发性细菌性腹膜炎诊断中的临床价值存在争议。在乙型肝炎相关性肝硬化中很少被讨论。我们研究了乙型肝炎相关性肝硬化患者自发性细菌性腹膜炎的最佳快速诊断方法。
分析了79例无菌性门静脉高压相关性腹水患者、31例自发性细菌性腹膜炎患者、16例肝细胞癌患者、15例恶性肿瘤相关性腹水患者和9例其他杂病患者的腹水多形核细胞计数、腹水pH值、动脉-腹水pH梯度、腹水乳酸水平和动脉-腹水乳酸梯度。
腹水多形核细胞计数≥250个细胞/mm³作为临界值时，自发性细菌性腹膜炎诊断的敏感性、特异性和准确性分别为100%、94%和95%；该值≥500个细胞/mm³时，敏感性、特异性和准确性分别为86%、98%和96%。以腹水pH值≤7.35作为临界值时，敏感性、特异性和准确性分别为29%、92%和80%；以动脉-腹水pH梯度≥0.1作为临界值时，分别为38%、91%和82%；以腹水乳酸水平≥32mg/dL作为临界值时，分别为52%、92%和85%；以动脉-腹水乳酸梯度≥20mg/dL作为临界值时，分别为38%、96%和85%。
尽管腹水pH值或乳酸水平的特异性尚可，但敏感性过低，无法辅助诊断乙型肝炎相关性肝硬化患者的自发性细菌性腹膜炎。腹水多形核细胞计数≥250个细胞/mm³或≥500个细胞/mm³是快速诊断自发性细菌性腹膜炎的主要且合适的辅助指标。
