In End Stage HBV-Associated Liver Disease With Spontaneous Bacterial Peritonitis:Diagnosis And Treatment

OBJECTIVE:To summarize the clinical characteristics 151 patients who were in end stage liver disease with SBP associated with HBV,take enhances to diagnosis and treatment of HBV-associated liver disease with SBP at the end stage.METHODS:The clinical data of 38 cases ofHBV-CLF with SBP,38patients of HBV-ACLF with SBP and75HBV-DC with SBP patients who were diagnosed and treatedfrom January 2012 to October 2018,admitted to the first affiliated hospital of Guangxi medical university.Clinical manifestations of patients and laboratory findings were analyzed by Statistical Package for Social Sciences.RESULTS:(1)Of the 151 in end stage HBV-associated liver disease withSBP,there were 131 cases with abdominal distension(86.8%),98 cases with abdominal tenderness(65%),67 cases with abdominal rebound pain(44.4%),37cases with abdominal muscle tension(23%),25 cases with fever(16.5%).HBV-ACLF with SBP fever was more obvious than HBV-DC with SBP(p=0.036),HBV-DC with SBP abdominal distension was obvious than HBV-ACLF with SBP.There was no significant difference in fever and abdominal distension between HBV-ACLF with SBP and HBV-CLF with SBP.(2)There were 146 cases(96.7%)of 151 patients with yellow appearance of ascites.There were 71 cases of ascites bacteriology culture which 9 cases(12.68%)of positive rate of ascites bacteria culture of5 cases of gram-negative bacteria(55.56%)and4 cases of gram-positive bacteria(44.44%).Mean number of nucleated cells in ascites>0.5×10~9/L.HBV-CLF withSBPNEU%wasmoreobviousthanHBV-DCwithSBP(p=0.007),HBV-DC with SBP Plt was obvious than HBV-ACLF with SBP,HBV-ACLF with SBP PCT?ALB?SAAG was obvious than HBV-DC with SBP.There was no significant difference in WBC?NLR?NEU%?CRP?PCT?ALB?SAAG between HBV-ACLF with SBP and HBV-CLF with SBP.(3)In151patients,piperacillin/tazobactamcombinedwith fluoroquinolones was the first choice for antibiotics in the initial SBP treatment,which was 59 cases(39.1%).In 59 cases,piperacillin/tazobactam combined with fluoroquinolones was effective in 27 cases(59.46%).In 31 cases,fluoroquinolones were effective in three generations of cephalosporins in 12cases(38.71%),fluoroquinolones alone in 7 cases(38.89%),and piperacillin/tazobactam alone in 11 cases(45.83%).There was no significant difference between piperacillin/tazobactam combined with fluoroquinolones,piperacillin/tazobactamaloneandcephalosporincombinedwith fluoroquinolones.HBV-DC with SBP in the efficiency of fluoroquinolones was obvious than HBV-ACLF with SBP(p=0.000).There was no significant difference in the efficiency of fluoroquinolones between HBV-ACLF with SBP and HBV-CLF with SBP.CONCLUSIONS:(1)Abdominal distension,abdominal tenderness and rebound pain were the most common symptoms of in end stage liver disease with SBP associated with HBV during early clinical symptoms.WBC values were low,PCT?CRP increased,ascites with nuclear cell number?SAAG increased,the positive rate of ascites culture was low.(2)Fluoroquinolones was the first choice for antibiotics in the initial HBV-DC with SBP treatment Single or in combination.(3)There was no significant difference in clinical symptoms and laboratory examination between HBV-ACLF with SBP and HBV-CLF with SBP.