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白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值

江萍 豆仁成 崔子瑾 佟印妮 李辰 姜珊珊 白云 郑吉敏 王存凯 王玉珍

江萍, 豆仁成, 崔子瑾, 等. 白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019
引用本文: 江萍, 豆仁成, 崔子瑾, 等. 白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值[J]. 临床肝胆病杂志, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019
JIANG P, DOU RC, CUI ZJ, et al. Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites[J]. J Clin Hepatol, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019
Citation: JIANG P, DOU RC, CUI ZJ, et al. Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites[J]. J Clin Hepatol, 2021, 37(9): 2097-2101. DOI: 10.3969/j.issn.1001-5256.2021.09.019

白蛋白-胆红素评分联合腹水中性粒细胞计数及降钙素原对肝硬化腹水患者发生自发性细菌性腹膜炎的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.09.019
基金项目: 

河北省2019年度医学科学研究课题 20190260

详细信息
    通讯作者:

    王存凯,wangcunkai@126.com

    王玉珍,wyzhen211@126.com

  • 中图分类号: R575.2

Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites

Funds: 

Medical Science Research Project of Hebei Province in 2019 20190260

  • 摘要:   目的  探讨影响肝硬化腹水患者发生自发性细菌性腹膜炎(SBP)的危险因素,并建立新的模型预测SBP的发生。  方法  选取河北省人民医院2016年9月—2020年9月确诊为肝硬化腹水患者215例,根据是否发生SBP,分为SBP组(n=55)与非SBP组(n=160)。收集患者临床资料并计算白蛋白-胆红素(ALBI)、MELD、MELD-Na、Child-Pugh等评分。计量资料两组间比较采用t检验或Mann-Whitney U检验; 计数资料两组间比较采用χ2检验; 经多因素logistic回归分析筛选出独立危险因素,绘制受试者工作特征曲线(ROC曲线),分析比较ALBI评分、降钙素原(PCT)、腹水中性粒细胞(PMN)计数及ALBI-PMN-PCT联合模型对SBP的诊断效能。  结果  非SBP组的Na+浓度(Z=-3.414,P=0.001)显著高于SBP组,TBil(Z=-2.720,P=0.007)、肌酐(Z=-1.994,P=0.046)、尿素氮(Z=-2.440,P=0.015)、CRP(Z=-9.137,P<0.001)、PCT(Z=-8.096,P<0.001)、PT(Z=-1.969,P=0.049)、INR(Z=-2.073,P=0.038)、PMN(Z=-8.292,P<0.001)、MELD评分(Z=-2.736,P=0.006)、MELD-Na评分(Z=-3.188,P=0.001)、Child-Pugh评分(Z=-3.419,P=0.001)、ALBI评分(t=-5.010,P<0.001)均明显低于SBP组; 两组是否伴有消化道出血、肝性脑病比较,差异均有统计学意义(χ2值分别为16.551、8.142,P值分别为<0.001、0.004)。多因素logistic回归分析结果显示,ALBI评分(OR=3.460,95%CI:1.296~9.240,P=0.013)、PMN(OR=1.012,95%CI:1.007~1.017,P<0.001)、PCT(OR=6.019,95%CI:2.821~12.843,P<0.001)是肝硬化腹水患者发生SBP的独立危险因素。ROC曲线结果显示,ALBI、PCT、PMN和ALBI-PMN-PCT诊断SBP的曲线下面积分别为0.711、0.866、0.875和0.934;灵敏度分别为50.91%、73.36%、72.73%和89.09%;特异度分别为86.87%、81.25%、100.00%和91.87%;ALBI-PMN-PCT>0.272时患者发生SBP的风险增加。  结论  ALBI-PMN-PCT联合模型对肝硬化腹水患者发生SBP具有较高的预测价值。

     

  • 图  1  PMN、ALBI、PCT和ALBI-PMN-PCT的ROC曲线

    表  1  肝硬化腹水患者一般资料比较

    变量 非SBP组(n=160) SBP组(n=55) 统计值 P
    年龄(岁) 63.25±13.04 62.82±13.79 t=0.209 0.835
    Alb(g/L) 28.00±5.10 26.76±5.55 t=1.532 0.127
    Na+(mmol/L) 137(134~140) 135(132~139) Z=-3.414 0.001
    尿素氮(mmol/L) 5.30(3.76~8.74) 6.87(5.00~10.30) Z=-2.440 0.015
    TBil(μmol/L) 32.1(22.1~59.4) 45.3(27.9~87.4) Z=-2.720 0.007
    肌酐(μmol/L) 67.7(59.2~79.1) 72.7(61.7~95.0) Z=-1.994 0.046
    PT(s) 14.3(13.0~16.4) 15.1(13.3~17.9) Z=-1.969 0.049
    INR 1.25(1.13~1.41) 1.32(1.16~1.58) Z=-2.073 0.038
    CRP(mg/L) 6.76(4.21~9.86) 30.56(17.63~48.00) Z=-9.137 <0.001
    PCT(ng/ml) 0.09(0.03~0.24) 1.46(0.38~2.67) Z=-8.096 <0.001
    PMN(×106/L) 48.5(27.3~131.3) 321.0(124.0~802.0) Z=-8.292 <0.001
    ABIC评分 7.89±1.33 8.20±1.52 t=-1.415 0.158
    ALBI评分 -1.45±0.52 -1.03±0.56 t=-5.010 <0.001
    Child-Pugh评分 8.0(7.0~10.0) 10.0(8.0~11.0) Z=-3.419 0.001
    MELD评分 7.91(4.78~11.07) 10.11(6.41~17.88) Z=-2.736 0.006
    MELD-Na评分 9.01(5.04~13.16) 11.92(8.50~20.75) Z=-3.188 0.001
    性别[例(%)] χ2=1.123 0.289
      男 107(66.9) 41(74.5)
      女 53(33.1) 14(25.5)
    消化道出血[例(%)] χ2=16.551 <0.001
      是 42(26.25) 31(56.36)
      否 118(73.75) 24(43.64)
    肝性脑病[例(%)] χ2=8.142 0.004
      是 16(10.0) 14(25.5)
      否 144(90.0) 41(74.5)
    病因[例(%)] χ2=2.995 0.386
      病毒性肝炎 109(68.1) 31(56.4)
      酒精性肝病 28(17.5) 14(25.5)
      自身免性肝病 13(8.1) 5(9.1)
      隐源性肝病 10(6.3) 5(9.1)
    下载: 导出CSV

    表  2  单因素logistic回归分析

    指标 OR 95%CI P
    ALBI评分 4.310 2.283~8.138 <0.001
    Child-Pugh评分 1.290 1.093~1.521 0.003
    MELD评分 1.064 1.019~1.111 0.005
    PMN 1.012 1.008~1.016 <0.001
    PCT 6.203 3.436~11.198 <0.001
    肝性脑病 3.073 1.385~6.817 0.006
    消化道出血 3.629 1.916~6.874 <0.001
    下载: 导出CSV

    表  3  多因素logistic回归分析

    指标 回归系数 OR 95%CI P
    PMN 0.012 1.012 1.007~1.017 <0.001
    ALBI评分 1.241 3.460 1.296~9.240 0.013
    PCT 1.795 6.019 2.821~12.843 <0.001
    下载: 导出CSV

    表  4  PMN、ALBI评分、PCT及ALBI-PMN-PCT对SBP的预测价值

    指标 最佳临界点 AUC(95%CI) 灵敏度(%) 特异度(%) 约登指数
    PMN 242×106/L 0.875(0.823~0.916) 72.73 100.00 0.727
    ALBI评分 -0.92 0.711(0.646~0.771) 50.91 86.87 0.378
    PCT 0.35 ng/ml 0.866(0.814~0.909) 73.36 81.25 0.576
    ALBI-PMN-PCT 0.272 0.934(0.892~0.963) 89.09 91.87 0.810
    下载: 导出CSV
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  • 收稿日期:  2021-01-04
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