结核性腹膜炎的诊断研究进展

Research Advances in the Diagnosis of Tuberculous Peritonitis

摘要: 结核性腹膜炎作为结核病在肺外的特殊表现形式，在所有结核病例中占比处于0.10%至3.50%之间。其临床表现多样，患者常伴有低热、盗汗、乏力等全身中毒症状，同时还会出现腹痛、腹胀以及发热等不适。由于这些症状缺乏特异性，结核性腹膜炎的早期诊断一直是临床面临的棘手难题。在血清学检查方面，血沉(ESR)和C反应蛋白(CRP)常会升高，即便如此它们并非结核性腹膜炎所特有。T-SPOT试验虽特异性较高，达93.13%，却无法有效区分活动性结核、陈旧性结核以及结核潜伏感染。CA125水平在结核性腹膜炎患者中会升高，且随治疗进程逐渐下降，可用于评估治疗效果。影像学检查中，腹部超声和CT在初步筛查和确诊结核性腹膜炎时发挥着重要作用。PET-CT虽敏感度高，在这种情况下因费用高昂，限制了其广泛应用。有创检查如腹水穿刺，涂片和培养的阳性率较低。分子检测Xpert MTB/RIF敏感性有限。本研究致力于系统总结结核性腹膜炎的诊断方法，为临床诊断提供切实可行的参考，助力提升结核性腹膜炎的早期检出率。

Abstract: Tuberculous peritonitis, as a special extra-pulmonary manifestation of tuberculosis, accounts for 0.10% to 3.50% of all tuberculosis cases. Its clinical manifestations are diverse, and patients are often accompanied by systemic poisoning symptoms such as low fever, night sweats, fatigue, and other discomfort, such as abdominal pain, abdominal distension, and fever. Due to the lack of specificity of these symptoms, the early diagnosis of tuberculous peritonitis has been a difficult clinical problem. In terms of serologic studies, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often elevated, although they are not specific to tuberculous peritonitis. Although T-SPOT assay had a high specificity of 93.13%, it could not effectively distinguish active tuberculosis, old tuberculosis and latent tuberculosis infection. The level of CA125 will increase in patients with tuberculous peritonitis and gradually decrease with the treatment process, which can be used to evaluate the treatment effect. Among the imaging examinations, abdominal ultrasound and CT play an important role in the initial screening and diagnosis of tuberculous peritonitis. Although PET-CT is highly sensitive, its widespread use in this setting is limited by its high cost. Invasive tests such as ascites puncture, smear and culture have a low positive rate. The sensitivity of Xpert MTB/RIF is limited. This study aims to systematically summarize the diagnostic methods of tuberculous peritonitis, provide practical reference for clinical diagnosis, and help improve the early detection rate of tuberculous peritonitis.