NLR、LMR和PNI在肝硬化相关自发性细菌性腹膜炎抗感染治疗中的作用

Role of NLR,LMR and PNI in anti-infective therapy of liver cirrhosis related spontaneous bacterial peritonitis

目的探讨血液标志物用于评估自发性细菌性腹膜炎(SBP)抗感染疗效的临床价值。方法收集2017年1月至2021年1月住院的肝硬化腹水患者的医疗记录,以抗感染治疗期间腹水多形核细胞相对变化(PMNL%)为标准,分为治疗有效组和无效组。计算中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)和预后营养指数(PNI)。采用二元Logistic回归模型评估疗效的影响因素。采用受试者工作特征(ROC)曲线分析各指标判断疗效的效能。结果共纳入102例SBP患者,抗感染治疗有效组70例,无效组32例。与无效组相比,有效组患者基线PNI明显增高(P=0.002),而血清尿素氮水平则显著降低(P=0.002)。Spearman相关分析显示腹水PMNL%与LMR%呈负相关(r=-0.429,P<0.001),与NLR%呈正相关(r=0.484,P<0.001)。ROC曲线分析显示,治疗期间LMR%和NLR%判断疗效的曲线下面积(AUC)分别为0.751和0.785,临界值分别为-6.7%和12.5%;两者联合判断疗效的AUC为0.834,灵敏度为90.2%,特异度为65.1%。多变量回归分析显示基线PNI≤33.1和有消化道出血是抗感染疗效不佳的危险因素。结论PNI、NLR和LMR作为非侵入性标志物对SBP患者的抗感染疗效具有预测和判断价值。

Objective To explore the clinical value of blood markers in evaluating the anti-infection efficacy of spontaneous bacterial peritonitis(SBP).Methods The medical records of the inpatients with liver cirrhosis in this hospital from January 2017 to January 2021 were collected.The patients were divided into the effective group and ineffective group according to the relative change of ascites polymorphonuclear leukocyte(PMNL%)during antiinfection treatment period.The neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR)and prognostic nutritional index(PNI)were calculated.The binary Logistic regression model was adopted to evaluate the influencing factors of effect.The receiver operating characteristic(ROC)curve was adopted to analyze the efficiency of each indicator for judging the effect.Results A total of 102 patients with SBP were included,including 70 cases in the effective group and 32 cases in the ineffective group.The baseline PNI level in the effective group was significantly higher that in the ineffective group(P=0.002),whereas serum urea nitrogen level was significantly decreased(P=0.002).The Spearman correlation analysis showed that the ascites PMNL%was negatively correlated with LMR%(r=-0.429,P<0.001),and positively correlated with NLR%(r=0.484,P<0.001).The ROC curve analysis showed that the area under the curve(AUC)of LMR%and NLR%for judging the effect during the treatment period was 0.751 and 0.785,respectively,their critical values were-6.7%and 12.5%,respectively.AUC of their combination was 0.834,the sensitive was 90.2%,and the specificity was 65.1%.The multivariate regression analysis showed that the base line PNI≤33.1 and gastrointestinal bleeding were the risk factors of poor anti-infection efficacy.Conclusion PNI,NLR and LMR as non-invasive markers have the predictive and diagnostic values for the anti-infection treatment effect in the patients with SBP.