肝硬化腹水并发结核性腹膜炎的预警指标分析

Analysis of early warning indicators of tuberculous peritonitis in patients with cirrhotic ascites

目的分析肝硬化腹水并发结核性腹膜炎预警指标。方法回顾性分析2010年1月至2012年12月重庆医科大学附属第二医院62例肝硬化腹水患者的临床资料。其中肝硬化腹水并发结构性腹膜炎(TBP)患者27例(TBP组);肝硬化腹水未发生TBP患者35例(非TBP组),收集2组患者的临床情况和实验室检查结果。采用χ2检验和Mann-Whitney U检验进行单因素分析;Logistic回归多因素检验进行多因素分析。结果性别、原发性腹膜炎病史、血沉(ESR)、血清结核抗体、腹水淋巴细胞为主(≥50%)及凝血酶原活动度(PTA)等指标在2组的差异具有统计学意义(P<0.05)。原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞为主(≥50%)的肝硬化腹水患者发生结核性腹膜炎的OR分别为1.933、3.205、2.716、11.701;其工作特征曲线(ROC)下面积(AUC)分别是0.831、0.815、0.775、0.935,P值均<0.05。结论既往有原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞≥50%是肝硬化腹水患者发生结核性腹膜炎的预警指标;各预警指标的预测价值均较好,尤其腹水淋巴细胞为主(≥50%)预测价值最大。

Objective To analyze the early warning indicators of tuberculous peritonitis （TBP） in patients with cirrhotic ascites. Methods A retrospective analysis was performed on the clinical data of 62 patients with cirrhotic aseites hospitalized in the Second Affiliated Hospital of Chongqing Medical University from January 2010 to December 2012. The chi - square test and Mann - Whitney U test were used for uni- variate analysis, while the logistic regression model was used for multivariate analysis. Results There were significant differences between TBP group and non -TBP group in sex, history of primary peritonitis, erythroeyte sedimentation rate （ESR） , serum tuberculosis antibody, percentage of lymphocytes in ascites （≥50% ） , and prothrombin activity （PTA） （P 〈0.05 for all）. The odds ratios （ORs） of history of primary peritonitis, PTA, ESR, and percentage of lymphoeytes in ascites （ ≥50% ） for development of TBP in patients with cirrhotic aseites were 1. 933, 3. 205, 2. 716, and 11. 701, respectively （P 〈0.05 for all）, and the areas under the receiver operating characteristic curve were 0. 831,0. 815, 0.775, and 0.935, respectively （P 〈 0.05 for all）. Conclusion History of primary peritonitis, PTA, ESR, and percentage of lymphocytes in aseites （ ≥50% ） are the early warning indicators of TBP in patients with cirrhotic aseites; these early warning indicators, especially percentage of lymphocytes in aseites （ ≥50% ） , have good predictive values.