CAJ | 학술논문

目的：评价腹水多形核细胞（PMN）数量与自发性腹膜炎（SBP）的预后关系。方法连续收集近2年间收治的291例 SBP 患者的临床资料。排除继发性、结核性腹膜炎，恶性腹水，并剔除未行腹穿或穿刺失败者40例，纳入研究的患者251例。以腹水 PMN 计数是否﹥250×106/ L 分为两组。比较两组间的一般情况、实验室检查、临床症状体征、合并症、治疗效果和生存率。结果在251例 SBP 患者中，PMN ﹥250×106/ L 者63例（25%），PMN ﹤250×106/ L 者188例（75%）。腹水细菌培养阳性的9例患者中，PMN ﹥250×106/ L 者占77.8%（7/9），PMN ﹤250×106/ L 者占22.2%（2/9）。两组患者在 SBP 主要症状体征方面无明显差别，均表现为有不同程度的发热、腹痛、腹胀，腹部张力增高，程度不等的压痛、反跳痛。抗菌药物治疗总有效率为67.3%（169/251），其中，PMN ﹤250×106/ L 组抗菌药物治疗有效率为70.7%（133/188），PMN ﹥250×106/ L 组为57.1%（36/63），两组比较差异有统计学意义（P ﹤0.05）。在合并症方面，与 PMN ﹤250×106/ L 组比较，PMN ﹥250×106/ L 组合并消化道出血、MODS、感染性休克较高（P均﹤0.05），其住院病死率及其1年内病死率均较高，差异均有统计学意义（P ﹤0.05）。结论以 PMN ﹥250×106/ L 作为 SBP 的诊断标准，在 SBP 患者预后评估中具有重要意义。与 PMN ﹤250×106/ L 的 SBP 患者比较，PMN ﹥250×106/ L 的 SBP 患者抗菌药物治疗有效率低，合并症较高，预后较差。
목적：평개복수다형핵세포（PMN）수량여자발성복막염（SBP）적예후관계。방법련속수집근2년간수치적291례 SBP 환자적림상자료。배제계발성、결핵성복막염，악성복수，병척제미행복천혹천자실패자40례，납입연구적환자251례。이복수 PMN 계수시부﹥250×106/ L 분위량조。비교량조간적일반정황、실험실검사、림상증상체정、합병증、치료효과화생존솔。결과재251례 SBP 환자중，PMN ﹥250×106/ L 자63례（25%），PMN ﹤250×106/ L 자188례（75%）。복수세균배양양성적9례환자중，PMN ﹥250×106/ L 자점77.8%（7/9），PMN ﹤250×106/ L 자점22.2%（2/9）。량조환자재 SBP 주요증상체정방면무명현차별，균표현위유불동정도적발열、복통、복창，복부장력증고，정도불등적압통、반도통。항균약물치료총유효솔위67.3%（169/251），기중，PMN ﹤250×106/ L 조항균약물치료유효솔위70.7%（133/188），PMN ﹥250×106/ L 조위57.1%（36/63），량조비교차이유통계학의의（P ﹤0.05）。재합병증방면，여 PMN ﹤250×106/ L 조비교，PMN ﹥250×106/ L 조합병소화도출혈、MODS、감염성휴극교고（P균﹤0.05），기주원병사솔급기1년내병사솔균교고，차이균유통계학의의（P ﹤0.05）。결론이 PMN ﹥250×106/ L 작위 SBP 적진단표준，재 SBP 환자예후평고중구유중요의의。여 PMN ﹤250×106/ L 적 SBP 환자비교，PMN ﹥250×106/ L 적 SBP 환자항균약물치료유효솔저，합병증교고，예후교차。
Objective To evaluate the relationship between ascites polymorphonuclear cell(PMN)count and prognosis of spontane-ous bacterial peritonitis(SBP). Methods We collected the clinical data of 291 cases of patients with SBP ever treated in recent 2 years in our hospital,and cases of secondary or tuberculous bacterial peritonitis,malignant ascites were excluded,together with 40 cases without ab-dominal paracentesis or with paracentesis failure. Statistical analysis was made based on the clinical data from the rest 251 patients,which were divided into two groups according to whether or not their PMN count to be higher than 250 × 106 / L. Then,the general conditions,labo-ratory examinations,clinical symptoms and signs,complications,therapeutic effect and survival rate between the two groups were compared. Results In 251 cases of SBP patients,the PMN count of 63 cases were higher than 250 × 106 / L(25% ),and 188 cases were lower than 250 × 106 / L(75% ). Ascites bacterial culture in 9 cases was positive,in which cases with PMN count ﹥ 250 × 106 / L accounted for 77. 8%(7 / 9)and PMN count ﹤ 250 × 106 / L accounted for 22. 2%(2 / 9). Further analysis revealed that the most common symptoms and signs of SBP,which manifested as fever,abdominal pain,abdominal distension,increased abdominal tension,tenderness and rebound tenderness, had no significant difference between the two groups. The total effective rate of antibiotic therapy was 67. 3%(169 / 251),andthe effective rate of cases with PMN count ﹤ 250 × 106 / L and cases with PMN count ﹥ 250 × 106 / L were 70. 7%(133 / 188),57. 1%(36 / 63),with significant difference between them(P ﹤ 0. 05). When compared with PMN count ﹤ 250 × 106 / L cases,the incidence of complications such as gastrointestinal bleeding,MODS,septic shock,in cases with PMN count ﹥ 250 × 106 / L was higher(P ﹤ 0. 05),and the hospital mortali-ty rate and the mortality rate within 1 year were also higher(P ﹤ 0. 05). Conclusion It has important significance in evaluating the progno-sis of SBP patients to define PMN count ﹥ 250 × 106 / L as diagnosis criteria of SBP. The SBP patients with PMN count ﹥ 250 × 106 / L had lower effective rate of antibiotic therapy,higher complication incidence and poorer prognosis than those with PMN count ﹤ 250 × 106 / L.