C反应蛋白与白蛋白比值对酒精性肝硬化合并自发性细菌性腹膜炎的诊断价值

Clinical value of C-reactive protein/albumin ratio in the diagnosis of alcoholic cirrhosis with spontaneous bacterial peritonitis

目的分析C反应蛋白/白蛋白比值(CAR)判断酒精性肝硬化(ALC)患者是否合并自发性细菌性腹膜炎(SBP)的临床价值。方法回顾性选取2020年8月—2022年2月首都医科大学附属北京地坛医院住院的ALC患者329例,根据入院时是否合并SBP分为ALC未合并SBP组(n=246)和ALC合并SBP组(n=83),比较两组患者的性别、年龄、合并症、并发症、血常规、肝肾功能、血脂和凝血指标。符合正态分布的计量资料两组间比较采用成组t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。多因素二元Logistic回归分析判断发生SBP的危险因素,绘制CAR的受试者工作特征曲线(ROC),计算曲线下面积(AUC)、最佳截断值和95%CI。结果合并SBP患者的WBC、中性粒细胞、中性粒细胞/淋巴细胞比值、单核细胞、C反应蛋白(CRP)、CAR等炎性指标水平均高于未合并SBP患者,前者的AST、TBil、INR、MELD评分高于后者,而Alb、HDL水平显著低于后者(P值均<0.05)。多因素Logistic回归分析发现CAR(OR=20.628,95%CI:6.720~74.052,P<0.01)、RBC(OR=0.600,95%CI:0.381~0.932,P=0.025)是判断ALC患者是否合并SBP的独立危险因素。与NLR(AUC=0.725)、WBC(AUC=0.651)相比,CAR的AUC(AUC=0.825)明显较高。CAR的最佳截断值为0.324,分组后显示高风险组合并SBP的比例是63.2%(55/87),显著高于低风险组的11.6%(28/242)(χ^(2)=90.495,P<0.01)。结论CAR是判断ALC患者发生SBP的良好标志物。

Objective To investigate the clinical value of C-reactive protein/albumin ratio(CAR)in determining spontaneous bacterial peritonitis(SBP)in patients with alcoholic cirrhosis(ALC).Methods A retrospective analysis was performed for 329 ALC patients with SBP who were hospitalized in Beijing Ditan Hospital,Capital Medical University,from August 2020 to February 2022,and according to the presence or absence of SBP on admission,they were divided into non-SBP group with 246 patients and SBP group with 83 patients.The two groups were compared in terms of sex,age,comorbidities,complications,blood routine,liver and renal function,blood lipids,and coagulation markers.The independent-samples t test was used for comparison of normally distributed quantitative data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed quantitative data between two groups;the chi-square test was used for comparison of qualitative data between two groups.A multivariate binary logistic regression analysis was used to identify the risk factors for SBP.The receiver operating characteristic(ROC)curve was plotted for CAR to calculate the area under the ROC curve(AUC),the optimal cut-off value,and 95%confidence interval(CI).Results Compared with the non-SBP patients,the SBP patients had significantly higher inflammatory indicators(WBC,neutrophils,NLR,monocytes,C-reactive protein,and CAR),significantly higher aspartate aminotransferase,total bilirubin,international normalized ratio,and MELD score,and significantly lower levels of albumin and high-density lipoprotein(all P<0.05).The multivariate logistic regression analysis showed that CAR(odds ratio[OR]=20.628,95%CI:6.720-74.052,P<0.01)and red blood cell count(OR=0.600,95%CI:0.381-0.932,P=0.025)were independent risk factors for determining SBP in ALC patients.CAR had a significantly larger AUC than NLR and WBC(0.825 vs 0.725/0.651)and an optimal cut-off value of 0.324.The patients were divided into high-risk group and low-risk group,and the analysis showed that the high-risk group had a significantly higher proportion of patients with SBP than the low-risk group[63.2%(55/87)vs 11.6%(28/242),χ^(2)=90.495,P<0.01].Conclusion CAR is a good marker for determining SBP in patients with ALC.