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

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

1.
河北北方学院研究生学院，河北张家口 075000
2.
河北省人民医院消化科，石家庄 050000

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
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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

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

1.
Graduate School of Hebei North University, Zhangjiakou, Hebei 075000, China
2.
Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China

Research funding:

Medical Science Research Project of Hebei Province in 2019 (20190260)

摘要

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。
- 肝硬化 /
- 腹膜炎 /
- 腹水 /
- 降钙素 /
- 白蛋白-胆红素评分
Abstract: Objective To investigate the risk factors for spontaneous bacterial peritonitis (SBP) in patients with cirrhotic ascites, and to establish a new model for predicting the development of SBP. Methods A total of 215 patients who were diagnosed with cirrhotic ascites in Hebei General Hospital from September 2016 to September 2020 were enrolled, and according to the presence or absence of SBP, they were divided into SBP group with 55 patients and non-SBP group with 160 patients. Related clinical data were collected and albumin-bilirubin (ALBI) score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and Child-Pugh score were calculated. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to screen out independent risk factors, and the receiver operating characteristic (ROC) curve was plotted to evaluate the performance of ALBI score, procalcitonin (PCT), polymorphonuclear neutrophil (PMN) count in ascites, and the ALBI-PMN-PCT combined model in the diagnosis of SBP. Results Compared with the SBP group, the non-SBP group had a significantly higher concentration of Na⁺ (Z=-3.414, P=0.001) and significantly lower total bilirubin (Z=-2.720, P=0.007), creatinine (Z=-1.994, P=0.046), urea nitrogen (Z=-2.440, P=0.015), C-reactive protein (Z=-9.137, P < 0.001), PCT (Z=-8.096, P < 0.001), prothrombin time (Z=-1.969, P=0.049), international normalized ratio (Z=-2.073, P=0.038), PMN (Z=-8.292, P < 0.001), MELD score (Z=-2.736, P=0.006), MELD-Na score (Z=-3.188, P=0.001), Child-Pugh score (Z=-3.419, P=0.001), and ALBI score (t=-5.010, P < 0.001), and there were also significant differences between the two groups in the presence or absence of gastrointestinal bleeding or hepatic encephalopathy (χ²=16.551 and 8.142, P < 0.001 and P=0.004). The multivariate logistic regression analysis showed that ALBI score (odds ratio [OR]=3.460, 95% confidence interval [CI]: 1.296-9.240, P=0.013), PMN (OR=1.012, 95%CI: 1.007-1.017, P < 0.001), and PCT (OR=6.019, 95%CI: 2.821-12.843, P < 0.001) were independent risk factors for SBP in patients with cirrhotic ascites. The ROC curve showed that ALBI, PCT, PMN, and ALBI-PMN-PCT had areas under the ROC curve of 0.711, 0.866, 0.875, and 0.934, respectively, in the diagnosis of SBP, with sensitivities of 50.91%, 73.36%, 72.73%, and 89.09%, respectively, and specificities of 86.87%, 81.25%, 100.00%, and 91.87%, respectively. The patients with ALBI-PMN-PCT > 0.272 had an increased risk of developing SBP. Conclusion The ALBI-PMN-PCT combined model has a high value in predicting the onset of SBP in patients with cirrhotic ascites.
- Liver Cirrhosis /
- Peritonitis /
- Ascites /
- Calcitonin /
- Albumin-Bilirubin Score

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图 1 PMN、ALBI、PCT和ALBI-PMN-PCT的ROC曲线

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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值
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)

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表 2 单因素logistic回归分析

指标	OR	95%CI	P值
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

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表 3 多因素logistic回归分析

指标	回归系数	OR	95%CI	P值
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

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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

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