摘要
目的分析肝硬化腹水患者并发自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的危险因素,并探讨血小板-白蛋白-胆红素(platelet-albumin-bilirubin,PALBI)评分联合腹水多形核细胞百分比(polymorphonuclear percentage,PMN%)对肝硬化并发SBP的预测价值。方法选取2018年1月至2022年1月于徐州医科大学附属医院确诊为肝硬化腹水患者242例,SBP组67例,非SBP组175例。收集患者的一般资料、合并症及实验室指标。通过多因素二元Logistic回归模型筛选出独立危险因素,绘制ROC曲线获得最佳临界值并评估其预测价值。结果非SBP组的腹水ALB显著高于SBP组(P<0.05),血NEUT%、血WBC、INR、TBil、PT、腹水PMN%、腹水WBC、PALBI评分、白蛋白-胆红素(albumin-bilirubin,ALBI)评分、Child-Pugh评分、终末期肝病模型(model for end-stage liver disease,MELD)均明显低于SBP组(P<0.05);两组是否伴有肝肾综合征、肝性脑病比较,差异均有统计学意义(P<0.05)。多因素二元Logistic回归分析表明,PALBI评分、PMN%是其独立危险因素(P<0.05)。ROC曲线表明,PALBI评分、腹水PMN%及两者联合诊断SBP的曲线下面积分别为0.740、0.839和0.918;灵敏度分别为68.7%、70.1%和85.1%;特异度分别为73.7%、85.1%和86.2%。结论PALBI评分联合腹水PMN%对肝硬化腹水患者发生SBP具有较高的预测价值。
Objective To analyze the risk factors for spontaneous bacterial peritonitis(SBP)in patients with cirrhotic ascites,and explore the value of platelet-albumin-bilirubin(PALBI)score combined with ascites polymorphonuclear percentage(PMN%)in predicting SBP in patient with cirrhotic ascites.Methods A total of 242 patients with cirrhotic ascites who were admitted into the Affiliated Hospital of Xuzhou Medical University from Jan.2018 to Jan.2022 were enrolled.There were 67 cases in the SBP group and 175 cases in the non-SBP group.Their following data were collected:general information,complications and laboratory indicators.A multivariate Logistic regression analysis was used to screen out independent risk factors,then ROC curve was used to obtain the optimal critical value and predictive value of independent risk factors.Results Compared with the SBP group,the non-SBP group had a significantly higher concentration of ascites ALB(P<0.05),significantly lower the NEUT%,plasma WBC count,INR,TBil,PT,ascites PMN%,ascites WBC count,PALBI score,albumin-bilirubin(ALBI)score,Child-Pugh score and model for end-stage liver disease(MELD)(P<0.05).There were also significant differences between the two groups in the presence or absence of hepatorenalsyndrome or hepatic encephalopathy(P<0.05).The multivariate binary Logistic regression analysis showed that PALBI score and PMN%were independent risk factors for SBP in patients with cirrhotic ascites(P<0.05).The ROC curve showed that PALBI score,ascites PMN%,and the two combined had areas under the ROC curve of 0.740,0.839 and 0.918,respectively,in the diagnosis of SBP,with sensitivities of 68.7%,70.1%and 85.1%,respectively,and specificities of 73.7%,85.1%and 86.2%,respectively.Conclusion The PALBI score combined with ascites PMN%has a high value in predicting the onset of SBP in patients with cirrhotic ascites.
作者
路越虹
吴克俭
LU Yuehong;WU Kejian(Clinical College of Xuzhou Medical University,Xuzhou 221000;Department of Gastroenterology,the Affiliated Hospital of Xuzhou Medical University,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第10期1143-1146,1151,共5页
Chinese Journal of Gastroenterology and Hepatology
关键词
肝硬化
腹膜炎
PALBI评分
Liver cirrhosis
Peritonitis
Platelet-albumin-bilirubin score
