自发性细菌性腹膜炎（Spontaneous bacterial peritonitis）.docVIP

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自发性细菌性腹膜炎（Spontaneous bacterial peritonitis）.doc

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自发性细菌性腹膜炎（Spontaneous bacterial peritonitis）

自发性细菌性腹膜炎（Spontaneous bacterial peritonitis） Spontaneous bacterial peritonitis Update Date: 2007-12-02 click: Spontaneous bacterial peritonitis (spontaneous bacterial - peri tonitis, SBP) refers to the abdominal cavity or adjacent tissues no foci of infection of ascitic bacterial infection. In 1964, Conn first recognized the disease in patients with cirrhosis of the liver and ascites. Cirrhosis of the liver is the most common underlying disease of spontaneous bacterial peritonitis. Later, it was gradually found that spontaneous bacterial peritonitis also occurred in patients with acute liver failure and nephrotic syndrome, [1]. Recently, many units in China have carried out liver transplantation for end-stage liver disease. The spontaneous bacterial peritonitis aggravates the damage of liver function and increases the mortality during perioperative period of liver transplantation. Further understanding of the pathogenesis and treatment of spontaneous bacterial peritonitis is of great significance. 1 epidemiology and etiology The incidence of spontaneous bacterial peritonitis at admission was 10% to 30%[2] in cirrhotic patients with ascites. The incidence of gastrointestinal bleeding was higher in patients with previous SBP and lower levels of ascites protein. The incidence of SBP in fulminant hepatic failure was 19%. In 1960s, the mortality rate of SBP patients was as high as 90%. With the early diagnosis of the disease and the rational use of antibiotics, the mortality rate was 20% ~ 40%. The recurrence rate was 40% - 70% in 1 years after SBP. Pathogenic bacteria are often aerobic gut derived Gram-negative bacteria (49.5%) and non gut derived streptococci. The most common are Escherichia coli (43%), Klebsiella pneumoniae (3.6%) and pneumococcus (10%), and anaerobes are rare [3]. In recent years, there have been reports of SBP caused by Cryptococcus neoformans. 2 pathogenesis In patients with cirrhosis, especially those with advanced liver disease, a variety of immu