全身免疫炎症指数联合MELD对HBV相关慢加急性肝衰竭并发自发性细菌性腹膜炎及预后的预测价值  

Predictive value of systemic immunoinflammatory index combined with MELD for spontaneous bacterial peritonitis andprognosis in patients with acute-on-chronic liver failure associated with hepatitis B virus

作　　者：董旭 许明晓 徐爱静 葛玲玲 廖威 薛建亚 DONG Xu;XU Mingxiao;XU Aijing;GE Lingling;LIAO Wei;XUE Jianya(Department of Infectious Diseases,Changhai Hospital affiliated to Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长海医院感染科,上海200433

出　　处：《传染病信息》2023年第6期503-508,共6页Infectious Disease Information

摘　　要：目的探究全身免疫炎症指数(systemic immune-inflammation index,SII)联合终末期肝病模型(model for endstage liver disease,MELD)对HBV相关慢加急性肝衰竭(hepatitis B related acute-on-chronic liver failure,HBV-ACLF)并发自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)及预后的预测价值。方法回顾性分析308例就诊于海军军医大学附属长海医院感染科的HBV-ACLF患者资料,采用单因素与多因素分析HBV-ACLF并发SBP的危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评定SII联合MELD预测SBP发生与预后的性能。根据SII的最佳截断值将患者分为低SII组和高SII组,比较2组预后情况。绘制Kaplan-Meier曲线进行90 d生存分析。结果HBV-ACLF患者整体感染发生率为39.3%,其中SBP占75.2%。排除其他感染后将患者分为HBV-ACLF-无SBP组(187例)和HBVACLF-SBP组(91例)。2组间年龄、外周血白细胞计数、中性粒细胞计数、血小板计数、凝血酶原时间、国际标准化比值、总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、谷氨酰转肽酶、白蛋白、是否合并肝性脑病、肝肾综合征、消化道出血、腹水、MELD评分及SII差异均有统计学意义(P均<0.05)。二元Logistics回归分析显示,高SII(OR=1.003,95%CI:1.000~1.005,P=0.020)、合并腹水(OR=13.948,95%CI:4.617~42.140,P<0.01)及高MELD评分(OR=1.184,95%CI:0.995~1.410,P=0.018)是HBV-ACLF并发SBP的独立危险因素。ROC曲线分析显示,SII联合MELD评分预测HBV-ACLF并发SBP的曲线下面积(area under curve,AUC)为0.774,敏感度80.2%,特异度65.1%;预测预后为死亡的AUC为0.814,敏感度75%,特异度76.2%。高SII组HBV-ACLF患者病程中更易并发SBP、肝肾综合征和消化道出血,临床结局更差(P<0.05)。低SII低MELD组短期生存率更高(P<0.01)。结论高SII、腹水及高MELD评分是HBVACLF并发SBP的独立危险因素,SII联合MELD评分在HBV-ACLF患者SBP发生及其预后方面具有较好的�Objective To explore the predictive value of systemic immunoinflammatory index(SII)combined with model for end-stage liver disease(MELD)score for spontaneous bacterial peritonitis(SBP)and prognosis in patients with hepatitis B related acute-on-chronic liver failure(HBV-ACLF).Methods The data of 308 HBV-ACLF patients admitted to Department of Infectious Disease of Changhai Hospital Affiliated to Naval Medical University were retrospectively analyzed,and the risk factors of SBP were analyzed by univariate and multivariate analysis.Receiver operating characteristic(ROC)curve was used to evaluate the performance of SII combined with MELD score in predicting SBP and prognosis.The patients were divided into low SII group and high SII group according to the best cut-off value of SII,and the prognosis of the 2 groups was compared.Kaplan-Meier curves were used for 90 d survival analysis.Results The overall infection rate of HBV-ACLF was 39.3%,of which SBP accounted for 75.2%.There were differences in age,white blood cell count,neutrophil count,platelet count,prothrombin time,international standardized ratio,total bilirubin,alanine aminotransferase,glutamic oxalic aminotransferase,glutamyl transpeptidase,albumin,hepatic encephalopathy,hepatorenal syndrome,gastrointestinal hemorrhage,ascites,MELD score,and SII between the two groups(P<0.05).Binary Logistics regression analysis results showed that SII(OR=1.003,95%CI:1.000-1.005,P=0.02),combined ascites(OR=13.948,95%CI:4.617-42.140,P<0.01),and MELD score(OR=1.184,95%CI:0.995-1.410,P=0.018)were independent risk factors for HBV-ACLF complicated with SBP.ROC curve results showed that the AUC of SII combined with MELD score for predicting HBV-ACLF complicated with SBP was 0.774,sensitivity was 80.2%,and specificity was 65.1%,while the AUC for predicting clinical prognosis was 0.814,sensitivity was 75%,and specificity was 76.2%.HBV-ACLF patients in high SII group were more likely to be complicated with SBP,hepatorenal syndrome and gastrointestinal bleeding during the course of dis

关 键 词：全身免疫炎症指数 终末期肝病模型 乙型肝炎病毒 慢加急性肝衰竭 自发性细菌性腹膜炎 预后 预测 

分 类 号：R575.3[医药卫生—消化系统]