肝硬化并发自发性细菌性腹膜炎的临床研究进展

Advances in Clinical Research on Spontaneous Bacterial Peritonitis Complicating Liver Cirrhosis

摘要: 自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)是失代偿期肝硬化患者最常见的感染性并发症，也是驱动肝病进展、导致患者死亡的关键危险因素，流行病学数据显示，SBP首次感染的病死率仍高，若未能及时明确诊断并启动规范治疗，病情可快速进展，出现危及生命的危重事件，如感染性休克、肝肾功能衰竭等，直接影响肝硬化患者的远期生存结局。目前诊断SBP主要通过腹水多形核白细胞(PMN)计数和腹水培养为主要方法，但该方式存在敏感性低、耗时长、阳性率低等局限性。近年来，随着检验技术的发展，新型血清学及腹水生物学标志物以及宏基因组新一代测序的应用，为SBP的早期诊断提供了全新路径。基于此，本文围绕肝硬化合并SBP患者的病理生理演变过程、病原菌谱分布特征、现有临床诊断方案的优劣进行系统综述，旨在为提升SBP早期检出率提供理论参考，以期为SBP的早期识别、临床防控方案优化提供参考。

Abstract: Spontaneous bacterial peritonitis (SBP) is the most common infectious complication in patients with decompensated cirrhosis, and a key risk factor driving liver disease progression and leading to patient death. Epidemiological data shows that the mortality rate of the first infection of SBP is still high. If the diagnosis and standardized treatment are not promptly initiated, the condition can progress rapidly and life-threatening critical events such as septic shock and liver and kidney failure can occur, directly affecting the long-term survival outcomes of patients with cirrhosis. At present, the diagnosis of SBP mainly relies on the counting of polymorphonuclear leukocytes (PMN) in ascites and ascites culture, but this method has limitations such as low sensitivity, long time consumption, and low positivity rate. In recent years, with the development of testing technology, the application of new serological and ascites biomarkers, as well as next-generation metagenomic sequencing, has provided a new path for the early diagnosis of SBP. Based on this, this article provides a systematic review of the pathophysiological evolution process, pathogen spectrum distribution characteristics, and the advantages and disadvantages of existing clinical diagnostic schemes in patients with liver cirrhosis complicated with SBP. The aim is to provide theoretical reference for improving the early detection rate of SBP, and to provide reference for the early identification of SBP and the optimization of clinical prevention and control schemes.