肝硬化腹水并发无症状型自发性细菌性腹膜炎的常规指标分析与应用

Analysis and application of routine parameters in diagnosis of cirrhotic ascites complicated with asymptomatic spontaneous bacterial peritonitis

目的了解常用、易取指标对肝硬化腹水患者并发无症状型自发性细菌性腹膜炎(SBP)诊断价值。方法收集肝硬化腹水的住院患者病历资料,通过腹水常规检查及细菌培养结果分为并发无症状型SBP组(SBP组)及单纯性肝硬化腹水组(对照组),对比2组患者的临床资料,绘制受试者工作特征(ROC)曲线,分析组间差异有统计学意义的常用指标对肝硬化腹水患者并发无症状型SBP的诊断效能。结果共收集肝硬化腹水患者48例,其中并发无症状型SBP 25例(52%)。SBP组患者血清前白蛋白和白蛋白均高于对照组(P均<0.05)。2组患者的性别、年龄、住院时间、白细胞计数、中性粒细胞计数、中性粒细胞百分比、血小板计数、红细胞计数、ALT、AST、总胆红素、直接胆红素、总胆汁酸、血尿素氮、血清肌酐、总胆固醇、甘油三酯、LDL和HDL比较差异均无统计学意义(P均> 0.05)。ROC曲线显示,前白蛋白、白蛋白诊断无症状型SBP的最佳界值分别为63.1 mg/L、24.9 g/L。前白蛋白<63.1 mg/L、白蛋白<24.9 g/L、前白蛋白<63.1 mg/L且白蛋白<24.9 g/L(串联组合)和前白蛋白<63.1 mg/L或白蛋白<24.9 g/L(并联组合)诊断无症状型SBP灵敏度分别为0.640、0.440、0.400、0.680,前白蛋白的灵敏度高于串联组合、并联组合的灵敏度高于白蛋白及串联组合(P均<0.05)。前白蛋白、白蛋白、串联组合、并联组合诊断无症状型SBP的特异度分别为0.696、0.913、0.957、0.652,串联组合高于前白蛋白及并联组合(P均<0.05)。前白蛋白、白蛋白、串联组合、并联组合诊断无症状型SBP的ROC AUC比较差异无统计学意义(P均> 0.05)。结论血前白蛋白和白蛋白对肝硬化腹水患者并发无症状型SBP有一定的预测价值。

Objective To evaluate the diagnostic value of commonly-used and readily-available parameters for cirrhotic ascites complicated with asymptomatic spontaneous bacterial peritonitis(SBP). Methods Clinical data of the hospitalized patients with cirrhotic ascites were collected. All patients were divided into the cirrhotic ascites complicated with asymptomatic SBP group(SBP group) and SBP group(control group) by routine examination of ascites and bacterial culture test. Clinical data were statistically compared between two groups. The ROC curve was delineated. The diagnostic value of common parameters with statistical significance for cirrhotic ascites complicated with asymptomatic SBP was analyzed. Results A total of 48 cases of cirrhotic ascites were enrolled including 25 cases of asymptomatic SBP(52%). The serum levels of albumin and prealbumin in the SBP group were significantly higher compared with those in the control group(both P < 0.05). Gender, age, length of hospital stay, white blood cell count, neutrophil count, neutrophil percentage, platelet count, red blood cell count, alanine transaminase(ALT), aspertate aminotransferase(AST), total bilirubin, direct bilirubin, total bile acid, urea nitrogen, creatinine, total cholesterol, triglyceride, low-density lipoprotein(LDL) and high-density lipoprotein(HDL) did not significantly differ between two groups(all P > 0.05). The receiver operating characteristic(ROC) curve demonstrated that the cut-off values of serum albumin and prealbumin in the diagnosis of asymptomatic SBP were 24.9 g/L and 63.1 mg/L. The sensitivity of prealbumin < 63.1 mg/L, albumin < 24.9 g/L, prealbumin < 63.1 mg/L & albumin < 24.9 g/L, and prealbumin < 63.1 mg/L or albumin < 24.9 g/L groups in the diagnosis of asymptomatic SBP was 0.640, 0.440, 0.400 and 0.680, respectively. The sensitivity of prealbumin < 63.1 mg/L group was significantly higher than that of prealbumin < 63.1 mg/L & albumin < 24.9 g/L group, and the sensitivity of prealbumin < 63.1 mg/L or albumin < 24.9 g/L group was remarkably higher compared with those of albumin < 24.9 g/L group, and prealbumin < 63.1 mg/L & albumin < 24.9 g/L group(all P < 0.05). The specificity of prealbumin < 63.1 mg/L, albumin < 24.9 g/L, prealbumin < 63.1 mg/L & albumin < 24.9 g/L, and prealbumin < 63.1 mg/L or albumin < 24.9 g/L groups in the diagnosis of asymptomatic SBP was 0.696, 0.913, 0.957 and 0.652, respectively. The specificity of prealbumin < 63.1 mg/L & albumin < 24.9 g/L group was significantly higher compared with those of prealbumin < 63.1 mg/L group and prealbumin < 63.1 mg/L or albumin < 24.9 g/L group(both P < 0.05). The AUC values of albumin, prealbumin, prealbumin < 63.1 mg/L & albumin < 24.9 g/L, and prealbumin < 63.1 mg/L or albumin < 24.9 g/L groups were 0.697, 0.690, 0.678 and 0.666 with no statistical significance(all P > 0.05). Conclusion Serum albumin and prealbumin have diagnostic values for cirrhotic ascites complicated with asymptomatic SBP.