腹水多形核细胞计数联合全身免疫炎症指数和血清CRP/ALB比值诊断失代偿期肝硬化患者并发自发性细菌性腹膜炎价值研究*

doi:10.3969/j.issn.1672-5069.2025.06.019

摘要/Abstract

摘要： 目的探讨应用腹水多形核白细胞计数(PMN)联合全身免疫炎症指数(SII)和血清C反应蛋白(CRP)/白蛋白(ALB)比值预测失代偿期肝硬化患者并发自发性细菌性腹膜炎(SBP)的价值。方法 2021年4月～2025年4月我院收治的失代偿期肝硬化患者80例,常规检测血和腹水常规,检测血生化和血清C-反应蛋白(CRP),计算SII和CRP/ALB比值,采用Logistic回归分析和受试者工作特征曲线(ROC)评估各指标及其联合预测SBP发生的效能。结果在本组80例失代偿期肝硬化患者中,诊断SBP者31例(38.8%);SBP组肝功能Child-Pugh C级、肝性脑病和上消化道出血占比或发生率分别为51.6%、22.6%和45.2%,均显著高于非SBP组(分别为10.2%、0.0%和0.0%,P＜0.05);SBP组凝血酶原时间、血清白蛋白水平和外周血白细胞计数分别为(14.3±3.1) s、(29.7±0.5) g/L和(9.8±2.6)×10⁹/L,与非SBP组【分别为(12.9±2.9) s、(36.9±8.1) g/L和(7.1±1.9)×10⁹/L】比,差异显著(P＜0.05);SBP组腹水PMN为(270.2±70.4)×10⁶/L,显著高于非SBP组【(25.6±6.9)×10⁶/L,P＜0.05】,SII为(284.1±41.7),显著高于非SBP组【(221.7±28.9),P＜0.05】,血清CRP/ALB比值为(0.7±0.2),显著高于非SBP组【(0.4±0.1),P＜0.05】;Logistic回归分析显示,腹水PMN、SII和CRP/ALB比值均是影响失代偿期肝硬化患者并发SBP的危险因素(P＜0.05); ROC曲线分析显示,以腹水PMN联合SII或CRP/ALB比值诊断SBP的灵敏度为94.8%,特异度为98.0%。结论单纯依靠腹水PMN诊断失代偿期肝硬化患者并发SBP可能存在临床漏诊,而联合SII或CRP/ALB比值可提高诊断效能。

关键词: 失代偿期肝硬化, 自发性细菌性腹膜炎, 多形核白细胞计数, 全身免疫炎症指数, C反应蛋白/白蛋白比值, 诊断

Abstract: Objective The aim of this study was to explore the predictive efficacy of ascites polymorphonuclear leucocyte (PMN) counts and systemic immune-inflammation index (SII) and serum C-reactive protein (CRP)/albumin (ALB) ratio for spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis. Methods 80 patients with decompensated liver cirrhosis were admitted to our hospital between April 2021 and April 2025, blood and ascites routine, blood biochemical and serum CRP levels were obtained clinically, and SII and CRP/ALB ratio were calculated. The predictive efficacy was analyzed by using multivariate Logistic regression and receiver operating characteristic (ROC) curves. Results Of the 80 patients with decompensated liver cirrhosis, SBP was diagnosed in 31 cases(38.8%); percentage of Child-Pugh class C, hepatic encephalopathy and varices bleeding in SBP group were 51.6%, 22.6% and 45.2%, all much higher than 10.2%, 0.0% and 0.0% (P＜0.0) in non-SBP group; prothrombin time, serum albumin levels and peripheral white blood cell counts in SBP group were (14.3±3.1) s, (29.7±0.5) g/L and (9.8±2.6)×10⁹/L, all significantly different as compared to [(12.9±2.9) s,(36.9±8.1) g/L and (7.1±1.9)×10⁹/L, respectively, P＜0.05] in non-SBP group; ascites PMN count, SII and CRP/ALB ratio in patients with SBP were (270.2±70.4)×10⁶/L, (284.1±41.7) and (0.7±0.2), all significantly higher than [(25.6±6.9)×10⁶/L,(221.7±28.9) and (0.4±0.1), respectively, P＜0.05] in those without; Logistic regression analysis showed that ascites PMN, SII and CRP/ALB ratio were all the independent risk factors for SBP occurrence (P＜0.05); ROC analysis demonstrated that the sensitivity was 94.8% and the specificity was 98.0%, when ascites PMN was combined with SII or CRP/ALB ratio in predicting SBP complicated. Conclusion SII and/or CRP/ALB ratio is helpful in preventing underdiagnosis of SBP in patients with decompensated liver cirrhosis, if ascites PMN counts is alone relied on.

Key words: Decompensated liver cirrhosis, Spontaneous bacterial peritonitis, Systemic immune-inflammation index, Polymorphonuclear leucocyte, C-reactive protein /albumin ratio, Diagnosis

彭冬梅, 王栋, 谢晓卒. 腹水多形核细胞计数联合全身免疫炎症指数和血清CRP/ALB比值诊断失代偿期肝硬化患者并发自发性细菌性腹膜炎价值研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 874-877.

Peng Dongmei, Wang Dong, Xie Xiaojun. Predictive efficacy of ascites polymorphonuclear leucocyte counts and systemic immune-inflammation index and serum CRP/ALB ratio for spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(6): 874-877.

参考文献

[1] Abdo G, Nir U, Rawajdey R, et, al. A novel score-based approach by using routine laboratory tests for accurate diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. EJIFCC, 2023,34(4):297-304.
[2] 伍先梅,罗俊力,黄文祥,等. 肝硬化腹水患者的腹水endocan水平在自发性腹膜炎诊断中的作用. 第三军医大学学报,2020,42(13):1338-1344.
[3] Wang RH, Wen WX, Jiang ZP, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol, 2023,14:1115031.
[4] Kaçerİ, Çağlar A, Akıllı NB. The prognostic value of C-reactive protein/albumin ratio in acute mesenteric ischemia. Am Surg, 2023,89(5):1661-1667.
[5] 扈登财,杜莉,曹成红,等. 血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析. 实用肝脏病杂志,2020,23(5):699-702.
[6] 耿若彤,吴克俭. 基于SII、CAR的列线图模型对肝硬化腹水并发自发性细菌性腹膜炎的预测价值. 徐州医科大学学报,2024,44(10):740-746.
[7] 中华医学会肝病学分会. 肝硬化诊治指南. 中华肝脏病杂志,2019,27(11):846-865.
[8] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南. 实用肝脏病杂志,2018,21(1):21-31.
[9] 邢世磊,李之慧,宁秀景. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清MCP-1、TNF-α和IL-10水平变化及其与病情复发的关系研究. 实用肝脏病杂志,2024,27(4):563-566.
[10] Pose E, Piano S, Juanola A, et al. Hepatorenal syndrome in cirrhosis. Gastroenterology, 2024,166(4):588-604,e1.
[11] 杨三霞,戚昉,吴丽娟,等. 肝硬化并发自发性细菌性腹膜炎的危险因素及其与TRAF6基因多态性的关联. 中华医院感染学杂志,2024,34(5):698-702.
[12] 王菁,毕宁,方亮,等. 乙型肝炎肝硬化并发自发性细菌性腹膜炎患者CD64指数及血清sTREM-1和IL-6水平变化与肠黏膜屏障功能关系研究. 实用肝脏病杂志,2022,25(1):79-82.
[13] Silvey S, Patel NR, Tsai SY, et al. Higher rate of spontaneous bacterial peritonitis recurrence with secondary spontaneous bacterial peritonitis prophylaxis compared with no prophylaxis in 2 national cirrhosis cohorts. Am J Gastroenterol, 2025,120(5):1066-1075.
[14] Meurer A, Antoni C, Ebert MP, et, al. Spontaneous bacterial peritonitis caused by Listeria monocytogenes: A rare infection with very high leukocyte counts in ascitic fluid-case report and review of the literature. Clin Res Hepatol Gastroenterol, 2023,47(6):102130.
[15] 朱龙川,吴蔚,邹波,等. 第三代头孢菌素治疗社区获得性自发性细菌性腹膜炎的疗效预测模型. 临床肝胆病杂志,2022,38(11):2499-2504.
[16] 朱龙川,徐龙,张伟,等. 腹水多形核细胞百分比对症状性细菌性腹水的诊断价值. 中华传染病杂志,2018,36(6):371-373.
[17] Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: A review. JAMA, 2023,329(18):1589-1602.
[18] Efgan MG, Acar H, Kanter E, et, al. Role of systemic immune inflammation index, systemic immune response index, neutrophil lymphocyte ratio and platelet lymphocyte ratio in predicting peritoneal culture positivity and prognosis in cases of spontaneous bacterial peritonitis admitted to the emergency department. Medicina (Kaunas), 2024,60(8):1335.
[19] Lu W,Qu J, Yan L, et al. Efficacy and safety of mesenchymal stem cell therapy in liver cirrhosis: a systematic review and meta-analysis. Stem Cell Res Ther, 2023, 14(1):301.
[20] 熊飞翔,孟培培,江宇泳,等. 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. 临床肝胆病杂志,2023,39(8):1880-1885.

腹水多形核细胞计数联合全身免疫炎症指数和血清CRP/ALB比值诊断失代偿期肝硬化患者并发自发性细菌性腹膜炎价值研究^*

Predictive efficacy of ascites polymorphonuclear leucocyte counts and systemic immune-inflammation index and serum CRP/ALB ratio for spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis

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