C反应蛋白与白蛋白比值对糖尿病合并细菌性肝脓肿患者预后的价值

Serum C-reactive protein to albumin ratio in predicting prognosis of diabetic patients complicated with pyogenic liver abscess

目的探讨血清CRP与白蛋白比值(CAR)用于判断糖尿病合并细菌性肝脓肿(PLA)患者预后的价值。方法选取中国人民解放军联勤保障部队第九〇九医院2020年6月至2021年12月收治的糖尿病合并PLA患者79例为研究对象,根据第28天治疗效果将患者分为有效组56例和无效组23例。比较两组患者一般情况、症状、实验室检查指标。多因素logistic回归分析影响糖尿病合并PLA患者预后的危险因素,ROC曲线分析CAR预测患者预后的效能。结果无效组患者糖化血红蛋白(HbA_(1C))大于有效组,脓肿直径≥5 cm、多发肝脓肿、抗生素治疗比例均高于有效组,差异均有统计学意义(均P<0.05);两组患者PLT<100×10^(9)/L、AST>40 U/L、CRP>8 mg/L、HbA_(1C)>9%比例及CAR比较差异均有统计学意义(均P<0.05);多因素分析发现,CAR≥3.55、脓肿多发、AST>40 U/L、HbA_(1C)>9%、单使用抗生素治疗均是糖尿病合并PLA患者预后不良的危险因素(均P<0.05)。ROC曲线分析显示CAR预测患者预后的最佳截断值为3.55,AUC=0.823,P<0.01。结论CAR升高是糖尿病合并PLA患者预后不良的危险因素,临床上也需要综合考虑血糖水平、脓肿大小、脓肿个数和细菌培养结果等因素,为患者制定个体化治疗方案。

Objective To investigate the prognostic value of serum C-reactive protein(CRP)to albumin(Alb)ratio(CAR)in diabetic patients complicated with pyogenic liver abscess.Methods Clinical data of 79 diabetic patients complicated with pyogenic liver abscess admitted to the 909th Hospital of the PLA Joint Logistic Support Force from June2020 to December 2021 were retrospectively analyzed.According to the outcomes after treatment for 28 d,the patients were divided into effective group(n=56)and ineffective group(n=23).The general condition,symptoms and clinical manifestations,laboratory test indexes of the two groups were compared.ROC curve was used to analyze the predictive value of CAR in predicting prognosis;logistic multivariate analysis was used to analyze the factors influencing the therapeutic effect.Results The glycosylated hemoglobin(HbA_(1C)),the proportion of multiple liver abscess,abscess diameter≥5 cm and antibiotic treatment in the ineffective group were higher than those in the effective group(all P<0.05).There were significant differences in proportion of patients with PLT<100×10^(9)/L,AST>40 U/L,CRP>8 mg/L,HbA_(1C)>9%and CAR between 2groups(all P<0.05).Multivariate analysis showed that CAR≥3.55,multiple abscesses,AST>40 U/L,HbA_(1C)>9%and antibiotic therapy were independent risk factors for poor prognosis of diabetic patients complicated with pyogenic liver abscess(all P<0.05).The area under ROC curve(AUC)of CAR for prognosis of pyogenic liver abscess was 0.823(P<0.01)and the optimal cut-off value for diagnosis was 3.55.Conclusion The elevated CAR is a risk factor for poor prognosis of diabetic patients complicated with pyogenic liver abscess.It is also necessary to comprehensively consider blood glucose level,abscess size,abscess number,bacterial culture results and other factors in clinical practice to develop an individualized treatment plan for patients.