摘要
原发性腹膜炎是肝硬化失代偿期患者最常见的感染类型之一,可导致病情迅速进展,引起一系列严重后果。其发病机制主要与肠道屏障功能受损及肝硬化相关免疫功能障碍有关,按病原学的类型可以分为细菌、真菌、病毒,单独或混合感染。肝硬化失代偿期患者因为免疫功能障碍,感染时临床症状不典型、常规炎症指标不敏感的原因,容易造成漏诊。目前的诊断标准主要基于腹水的多型核细胞(PMN)数量来制定,治疗上以经验性抗感染治疗为主。用于病原学诊断的腹水培养阳性率低,耗时长,无法早期识别原发性腹膜炎并指导抗感染用药。在多重药耐药病原体(MDRO)感染日益增加的当下,肝硬化原发性腹膜炎患者早期、精准的抗感染治疗尤为重要。本文根据肝硬化原发性腹膜炎的诊断现状,介绍了现有的诊断方法,以寻求灵敏、快速的诊断,为临床医生提供参考,提高肝硬化原发性腹膜炎的早期病原学诊断率,改善患者的预后。
Primary peritonitis is one of the most common infection types in patients with decompensated cirrhosis,which could lead to rapid progression of the disease and a series of serious consequences.Its pathogenesis is mainly related to impaired intestinal barrier function and immune dysfunction associated with cirrhosis.According to different etiological the type,primary peritonitis could be induced by bacterial,fungal and viral with mixed-infection or mono-infections.Most patients are easy to be escaped the diagnosis of peritonitis because of the following immune dysfunction,atypical clinical manifestation and insensitive inflammatory indicators.The current diagnostic criteria and therapy are mainly based on the polymorphic nuclear cells(PMN)count of ascites,and empirical antibiotic treatment.However,ascites culture has not only lower positive rate but also returns results slowly,it is difficult to guide early therapy during progressive stage of this disease.At a time of increasing multi-drug resistant pathogen(MDRO)infection,early and accurate treatment is particularly crucial for patients with primary peritonitis.Based on current situation diagnosis of primary peritonitis associated with liver cirrhosis,this paper introduces the existing diagnostic methods aim to explore sensitive and rapid diagnosis,providing information for clinicians,increasing the early etiological diagnosis rate patients.
作者
韩晶
刘强
周晓琳
HAN Jing;LIU Qiang;ZHOU Xiaolin(Department of Infectious Diseases,Yichang Central People's Hospital(the First Clinical Medical College of Three Gorges University),Hubei Province,Yichang 443000,China)
出处
《中国当代医药》
CAS
2023年第8期54-58,共5页
China Modern Medicine
关键词
肝硬化
原发性腹膜炎
病原学
宏基因二代测序技术
Cirrhosis
Spontaneous peritonitis
Etiological
Metagenome next-generation sequencing
