[Spontaneous Bacterial Peritonitis].
[Spontaneous Bacterial Peritonitis].
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DOI：
10.4166/kjg.2018.72.2.56
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发表时间：
2018-08-25
影响因子：
--
通讯作者：
Song, Do Seon
中科院分区：
文献类型：
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作者：
Song, Do Seon
自发性细菌性腹膜炎（SBP）定义为肝硬化腹水患者发生的细菌感染，无任何明显的腹膜内感染，约占住院患者细菌感染的10-30%。肝硬化患者会出现SBP，因为肠道细菌和粘膜屏障的变化会增加细菌移位。此外，宿主免疫反应的降低不能清除细菌及其产物。SBP最常见的原因是革兰氏阴性菌，如大肠杆菌和克雷伯菌属，革兰氏阳性菌的感染正在增加。SBP的诊断标准是穿刺后腹水中多形核白细胞数>250/mm 3。如果确诊为SBP，应立即开始经验性抗生素治疗。经验性抗生素治疗应区分社区获得性感染和医院感染。伴有消化道出血或腹水蛋白浓度低的肝硬化患者应考虑一级预防，SBP恢复者应考虑二级预防。本文综述了SBP的病理生理、诊断、治疗和预防。
Spontaneous bacterial peritonitis (SBP) is defined as bacterial infections that occur in patients with cirrhosis and ascites without any significant intraperitoneal infection, accounting for approximately 10-30% of bacterial infections in hospitalized patients. SBP develops in patients with liver cirrhosis because bacterial translocations are increased by changes in the intestinal bacteria and mucosal barriers. In addition, the decreased host immune response cannot remove the bacteria and their products. The most common cause of SBP is Gram-negative bacteria, such as Escherichia coli and Klebsiella species, and infections by Gram-positive bacteria are increasing. SBP is diagnosed by the presence of >250 polymorphonuclear leukocyte/mm3 in ascites after paracentesis. If SBP is diagnosed, empirical antibiotic therapy should be started immediately. Empirical antibiotic treatment should distinguish between community acquired infections and nosocomial infections. Cirrhotic patients with gastrointestinal bleeding or low ascitic protein concentrations should consider primary prevention and those who recover from SBP should consider secondary prevention. This review describes the pathophysiology, diagnosis, treatment, and prevention of SBP.