BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhos...BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL. AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6- mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study. RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%- 25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%. CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and th展开更多
目的评价薄芝糖肽联合腹水浓缩回输对肝硬化合并自发性细菌性腹膜炎的临床疗效和安全性。方法入选56例肝硬化合并自发性细菌性腹膜炎患者,随机分为对照组28例和试验组28例,试验组进行薄芝糖肽4 m L,每天1次,联合腹水浓缩回输治疗;对照...目的评价薄芝糖肽联合腹水浓缩回输对肝硬化合并自发性细菌性腹膜炎的临床疗效和安全性。方法入选56例肝硬化合并自发性细菌性腹膜炎患者,随机分为对照组28例和试验组28例,试验组进行薄芝糖肽4 m L,每天1次,联合腹水浓缩回输治疗;对照组进行腹水浓缩回输治疗,均连续治疗2周。观察2组患者治疗前后脂多糖结合蛋白、肿瘤坏死因子-α和降钙素原水平,肝功能,并观察疗效和并发症情况。结果治疗后,2组患者脂多糖结合蛋白、肿瘤坏死因子-α和降钙素原水平均明显降低(P<0.05),且试验组明显低于对照组(P<0.05)。治疗后,试验组与对照组谷丙转氨酶降低,白蛋白水平明显升高(P<0.05),且试验组谷丙转氨酶明显低于对照组,而白蛋白水平明显高于对照组(P<0.05)。试验组治疗总有效率为82.14%,高于对照组的53.57%(P<0.05)。试验组并发症发生率为7.14%,明显低于对照组的32.14%(P<0.05)。结论薄芝糖肽联合腹水浓缩回输可有效治疗肝硬化合并自发性细菌性腹膜炎,改善患者临床症状,提高治疗效果。展开更多
文摘BACKGROUND Spontaneous peritonitis is an infection of ascitic fluid without a known intraabdominal source of infection. spontaneous fungal peritonitis (SFP) is a potentially fatal complication of decompensated cirrhosis, defined as fungal infection of ascitic fluid in the presence of ascitic neutrophil count of greater than 250 cells/mL. AIM To determine the prevalence of fungal pathogens, management and outcomes (mortality) of SFP in critically ill cirrhotic patients. METHODS Studies were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Scopus databases until February 2019. Inclusion criteria included intervention trials and observation studies describing the association between SFP and cirrhosis. The primary outcome was in-hospital, 1-mo, and 6- mo mortality rates of SFP in cirrhotic patients. Secondary outcomes were fungal microorganisms identified and in hospital management by anti-fungal medications. The National Heart, Lung and Blood Institute quality assessment tools were used to assess internal validity and risk of bias for each included study. RESULTS Six observational studies were included in this systematic review. The overall quality of included studies was good. A meta-analysis of results could not be performed because of differences in reporting of outcomes and heterogeneity of the included studies. There were 82 patients with SFP described across all the included studies. Candida species, predominantly Candida albicans was the fungal pathogen in majority of the cases (48%-81.8%) followed by Candida krusei (15%- 25%) and Candida glabrata (6.66%-20%). Cryptococcus neoformans (53.3%) was the other major fungal pathogen. Antifungal therapy in SFP patients was utilized in 33.3% to 81.8% cases. The prevalence of in hospital mortality ranged from 33.3% to 100%, whereas 1-mo mortality ranged between 50% to 73.3%. CONCLUSION This systematic review suggests that SFP in end stage liver disease patient is associated with high mortality both in the hospital and at 1-mo, and th
文摘目的评价薄芝糖肽联合腹水浓缩回输对肝硬化合并自发性细菌性腹膜炎的临床疗效和安全性。方法入选56例肝硬化合并自发性细菌性腹膜炎患者,随机分为对照组28例和试验组28例,试验组进行薄芝糖肽4 m L,每天1次,联合腹水浓缩回输治疗;对照组进行腹水浓缩回输治疗,均连续治疗2周。观察2组患者治疗前后脂多糖结合蛋白、肿瘤坏死因子-α和降钙素原水平,肝功能,并观察疗效和并发症情况。结果治疗后,2组患者脂多糖结合蛋白、肿瘤坏死因子-α和降钙素原水平均明显降低(P<0.05),且试验组明显低于对照组(P<0.05)。治疗后,试验组与对照组谷丙转氨酶降低,白蛋白水平明显升高(P<0.05),且试验组谷丙转氨酶明显低于对照组,而白蛋白水平明显高于对照组(P<0.05)。试验组治疗总有效率为82.14%,高于对照组的53.57%(P<0.05)。试验组并发症发生率为7.14%,明显低于对照组的32.14%(P<0.05)。结论薄芝糖肽联合腹水浓缩回输可有效治疗肝硬化合并自发性细菌性腹膜炎,改善患者临床症状,提高治疗效果。
