Clinical Analysis Of Cirrhosis Ascitic Complicated With Spontaneous Bacterial Peritonitis

Objective:Spontaneous bacterial peritonitis(SBP) is a frequent and severe complication of cirrhotic patients with ascites.The development of SBP could induce a poor prognosis,and the mortality rate is high.The objective of this study is to investigate the risk factors,clinical freature,diagnosis,treatment and prognosis of SBP in liver cirrhosis with ascites,and to provide a reliable basis for the clinical diagnosis and treatment of SBP in the cirrhotic patients with ascites.Methods:40 cases of hospitalized cirrhotic patients with SBP admitted to our hospital between May 2008 and Februay 2009 were collected.Their clinical data including general conditions,symptoms,signs,blood and ascites routine test,ascitic fluid protein level,bacterial culture of ascites,serum bilirubin level,treatment and turnover were analyzed in retrospective.Results:There were 35 males and 15 females.The age of 40 patients were between 26～80 years old,with a mean age of 55.03±12.88 years.,The major etiology of cirrhosis was chronic viral hepatitis B.All the patients had various degree symptoms and signs such as abdominal distention(92.5%),hypourocrinia(80%),fever(40%), abdominal tenderness(42.5%),and pain(37.5%),rebound tendeness(27.5%), abdominal muscle tension(22.5%),diarrhea(20%).Among them 23 patient(57.5%) had white blood cell(WBC) in ascites≥500×106/L,38 patients(95%) had neutrophilic granulocyte(PMN)ratio in ascites≥0.5.The mean value of total protein concentration in ascites was 8.43±4.84g/L,with less than 10g/L in 28 patients(70%).Ascetic fluid culture was positive in 13 patients(32.5%),the gram-negative bacteria were the most common pathogens found in 7 patient(53.8%),with Escherichia.coli in 5 patients 38.5%),and gram-positive bacteria were observed in 5 patients(38.5%),with Enterococcus in 4 patients(30.8%).Blastomyces albicans was found in 1 patient.There are 17 patients(42.5%) with WBC count＞10±109/L and 33 patients(82.5%) with leukocyte＞75%in the peripheral blood.32 patients(80%) had serum bilirubin level more than 51.3umol/L.24 cases(60%) were cured or improvement,11 cases(27.5%) were inefficacy or deterioration.5 cases(12.5%) were died.The development of hepatorenal syndrome occursed in 27.5%of patients,with upper gastrointestinal hemorrhage in 25%and hepatic encephalopathy in 22.5%.7 patients(17.5%) developped infectious shock.Conclusion:Signs and symptoms of SBP were various and atypical in cirrhotic patients with ascites.A diagnosis of SBP established on the basis of symptoms and signs was not acceptable.It must be based on the PMN cell count in ascitic fluid and/or the bacteria culture of ascetic fluid,The Gram-negative bacteria were still the most common pathogens.Gram-positive bacteria were observed with a relative increment. The fungus also can be detected.Low ascites albumin and high serum bilirubin were the risk factors for SBP.The development of SBP in cirrhotic patients with ascits indicated a poor prognosis,and the mortality was high.Early diagnosis and proper antibiotics therapy were critical to increase effect and improve prognosis.