自发性细菌性腹膜炎PPT课件.ppt

此ppt下载后可自行编辑 定义 自发性细菌性腹膜炎（Spontaneous Bacterial Peritonitis , SBP）指无腹腔脏器穿孔，炎症而发生的腹膜急性细菌性感染，是肝硬化门脉高压的常见并发症之一。典型临床表现为发热、腹痛和腹部压痛，血白细胞增高。 Spontaneous bacterial peritonitis(SBP) is a frequent and severe complication of cirrhotic patients with ascites. Although SBP has been described as occurring in different settings, such as nephrotic syndrome, heart failure; most SBP episodes develop in patients with end stage liver disease as a manifestation of liver failure. Ascitic fluid infection is blood-borne and in 90% of cases is monomicrobial. SBP分三个亚型： 1. 细菌培养阳性+腹水多形核白细胞增加； 2. 细菌培养阴性的白细胞性腹水（culture-negative neutrocytic ascites , CNNA）； 3. 细菌性腹水（bacterial ascites, BA）指腹水培养阳性而PMN不升高。 Prevalence of SBP All cirrhotic patients with ascites can develop SBP It is comprising 31% of all bacterial infection It has been estimated to be between 10-30% Approximately half the episodes of SBP are present at the time of hospital admission and the remainder are acquired during hospitalization 发生率 SBP最常发生于失代偿期肝硬化患者，也可见于其他腹水患者。 占住院肝硬化患者的10%~30% 无腹水者约10% 有腹水者20% 合并肝性脑病者高达36%。 病原学 腹水感染细菌主要来自胃肠道 90%以上为单一菌种感染 主要为需氧G—杆菌 大肠杆菌所致的SBP约占40%~50%。 SBP的病原学（n=263） 致病菌 病例数 % 大肠杆菌 121 46 链球菌属 80 30 肺炎克雷伯菌 24 9 G—需氧阴性菌 22 8 厌氧菌 2 <1 其他 15 6 Although the flora of the large intestine is most frequently anaerobic, their isolation as a causative bacteria of SBP is an infrequent event. WHY? Inability of anaerobes to translocate across the intestinal mucosa The high O2 content of the intestinal wall 发病机理 SBP患者腹水中分离出来的细菌多为胃肠道细菌，表明细菌来自胃肠道，但细菌经过什么途径进入腹水目前尚不清楚。可能的途径如下： 一，胃肠道细菌迁移 细菌通过肠壁直接到达腹腔 肝硬化时胃肠道内菌群失调，菌群上移。回肠末端、空回肠均有大肠杆菌生长。 酒精性肝硬化 30.3%有小肠细菌过度生长，健康者无 有腹水者 37.1%有小肠细菌过度生长，无腹水者 5.3% 小肠细菌过度生长者 30.7%发生SBP，高于不伴者（9.09%）。 但SBP大多为单一细菌感染，提示这一途径仅是SBP形成的可能原因之一。 淋巴液引流异常 肝硬化动物模型中肠系膜淋巴结细菌迁移（Bacterial tra