中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

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

引用本文:
Citation:

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)

利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:江萍、豆仁成、王存凯负责课题设计,资料分析,撰写论文; 崔子瑾、佟印妮、李辰、姜珊珊参与收集数据,修改论文; 郑吉敏、白云、王玉珍负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    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

Research funding: 

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
  • [1] MARCIANO S, DÍAZ JM, DIRCHWOLF M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: Incidence, outcomes, and treatment strategies[J]. Hepat Med, 2019, 11: 13-22. DOI: 10.2147/HMER.S164250.
    [2] PIANO S, FASOLATO S, SALINAS F, et al. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial[J]. Hepatology, 2016, 63(4): 1299-1309. DOI: 10.1002/hep.27941.
    [3] TANDON P, GARCIA-TSAO G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis[J]. Semin Liver Dis, 2008, 28(1): 26-42. DOI: 10.1055/s-2008-1040319.
    [4] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [5] JOHNSON PJ, BERHANE S, KAGEBAYASHI C, et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade[J]. J Clin Oncol, 2015, 33(6): 550-558. DOI: 10.1200/JCO.2014.57.9151.
    [6] DOMINGUEZ M, RINCÓN D, ABRALDES JG, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis[J]. Am J Gastroenterol, 2008, 103(11): 2747-2756. DOI: 10.1111/j.1572-0241.2008.02104.x.
    [7] PUGH RN, MURRAY-LYON IM, DAWSON JL, et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg, 1973, 60(8): 646-649. DOI: 10.1002/bjs.1800600817.
    [8] KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
    [9] RUF AE, KREMERS WK, CHAVEZ LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone[J]. Liver Transpl, 2005, 11(3): 336-343. DOI: 10.1002/lt.20329.
    [10] FASOLATO S, ANGELI P, DALLAGNESE L, et al. Renal failure and bacterial infections in patients with cirrhosis: Epidemiology and clinical features[J]. Hepatology, 2007, 45(1): 223-229. DOI: 10.1002/hep.21443.
    [11] PIANO S, BARTOLETTI M, TONON M, et al. Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections[J]. Gut, 2018, 67(10): 1892-1899. DOI: 10.1136/gutjnl-2017-314324.
    [12] SHIZUMA T. Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review[J]. World J Hepatol, 2018, 10(2): 254-266. DOI: 10.4254/wjh.v10.i2.254.
    [13] SCHWABL P, BUCSICS T, SOUCEK K, et al. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites[J]. Liver Int, 2015, 35(9): 2121-2128. DOI: 10.1111/liv.12795.
    [14] WANG Y, ZHANG Q. Analysis of risk factors for patients with liver cirrhosis complicated with spontaneous bacterial peritonitis[J]. Iran J Public Health, 2018, 47(12): 1883-1890.
    [15] WANG X, WANG BM, JIANG K, et al. The predictive value of end-stage liver disease model for spontaneous bacterial peritonitis in cirrhotic patients with ascites[J]. Chin J Intern Med, 2009, 48(8): 629-632. DOI: 10.3760/cma.j.issn.0578-1426.2009.08.005.

    王鑫, 王邦茂, 姜葵, 等. 终末期肝病模型对肝硬化腹水患者并发自发性腹膜炎的预测价值[J]. 中华内科杂志, 2009, 48(8): 629-632. DOI: 10.3760/cma.j.issn.0578-1426.2009.08.005.
    [16] CHEN PC, CHEN BH, HUANG CH, et al. Integrated model for end-stage liver disease maybe superior to some other model for end-stage liver disease-based systems in addition to Child-Turcotte-Pugh and albumin-bilirubin scores in patients with hepatitis B virus-related liver cirrhosis and spontaneous bacterial peritonitis[J]. Eur J Gastroenterol Hepatol, 2019, 31(10): 1256-1263. DOI: 10.1097/MEG.0000000000001481.
    [17] GOYAL SK, DIXIT VK, JAIN AK, et al. Assessment of the model for end-stage liver disease (MELD) score in predicting prognosis of patients with alcoholic hepatitis[J]. J Clin Exp Hepatol, 2014, 4(1): 19-24. DOI: 10.1016/j.jceh.2014.02.006.
    [18] ABU RAHMA MZ, MAHRAN ZG, SHAFIK EA, et al. The role of serum procalcitonin level as an early marker of ascitic fluid infection in post hepatitic cirrhotic patients[J]. Antiinflamm Antiallergy Agents Med Chem, 2021, 20(1): 61-67. DOI: 10.2174/1871523019666200303104932.
    [19] HU DC, DU L, CAO CH, et al. Serum procalcitonin and C-reactive protein levels in predicting spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J]. J Prac Hepatol, 2020, 23(5): 699-702. DOI: 10.3969/j.issn.1672-5069.2020.05.024.

    扈登财, 杜莉, 曹成红, 等. 血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析[J]. 实用肝脏病杂志, 2020, 23(5): 699-702. DOI: 10.3969/j.issn.1672-5069.2020.05.024.
    [20] CHEN SS, YAN HX, DU JP, et al. Association between Albumin-Bilirubin (ALBI) score and the relapse of autoimmune hepatitis[J]. J Med Res, 2019, 48(3): 70-76. DOI: 10.11969/j.issn.1673-548X.2019.03.017.

    陈帅帅, 颜海希, 杜菊萍, 等. 白蛋白-胆红素(ALBI)评分与自身免疫性肝炎复发的相关性[J]. 医学研究杂志, 2019, 48(3): 70-76. DOI: 10.11969/j.issn.1673-548X.2019.03.017.
    [21] CHEN RC, CAI YJ, WU JM, et al. Usefulness of albumin-bilirubin grade for evaluation of long-term prognosis for hepatitis B-related cirrhosis[J]. J Viral Hepat, 2017, 24(3): 238-245. DOI: 10.1111/jvh.12638.
    [22] CHAN AW, CHAN RC, WONG GL, et al. New simple prognostic score for primary biliary cirrhosis: Albumin-bilirubin score[J]. J Gastroenterol Hepatol, 2015, 30(9): 1391-1396. DOI: 10.1111/jgh.12938.
  • 加载中
图(1) / 表(4)
计量
  • 文章访问数:  622
  • HTML全文浏览量:  98
  • PDF下载量:  57
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-01-04
  • 录用日期:  2021-01-27
  • 出版日期:  2021-09-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回