老年酒精性肝硬化患者发生自发性细菌性腹膜炎的影响因素及多种炎症指标的预测价值  

The Influencing Factors of Spontaneous Bacterial Peritonitis in Elderly Patients with Alcoholic Cirrhosis and the Predictive Value of Multiple Inflammatory Indicators

作　　者：刘春雨 张燕 秦岚[1] 徐亚楠 Liu Chunyu;Zhang Yan;Qin Lan;Xu Yanan(Department of Emergency Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 101100)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京101100

出　　处：《国际老年医学杂志》2024年第4期448-453,共6页International Journal of Geriatrics

基　　金：国家自然科学基金资助项目(82274131)。

摘　　要：目的 探究老年酒精性肝硬化患者发生自发性细菌性腹膜炎的影响因素及多种炎症指标的预测价值。方法 选取2020年1月—2023年6月首都医科大学附属北京友谊医院住院治疗的276例酒精性肝硬化患者进行回顾性分析,入院时合并自发性细菌性腹膜炎的72例老年酒精性肝硬化患者为观察组,未合并自发性细菌性腹膜炎的204例老年酒精性肝硬化患者为对照组。通过电子病历系统收集两组患者入院时的临床资料,采用多因素logistic回归模型分析炎症因子与自发性细菌性腹膜炎的相关性,采用ROC曲线评估炎症因子对自发性细菌性腹膜炎的诊断效能。结果 单因素分析显示,观察组合并糖尿病、肝性脑病、上消化道出血的比例高于对照组,凝血酶原时间长于对照组,中性粒细胞与淋巴细胞的比值(NLR)、C反应蛋白与白蛋白的比值(CAR)高于对照组,淋巴细胞与单核细胞的比值(LMR)低于对照组,差异均有统计学意义(P<0.05)。多因素logistic回归模型结果显示,上消化道出血、NLR、CAR是老年肝硬化患者发生自发性细菌性腹膜炎的独立危险因素(P<0.05),LMR是其保护因素(P<0.05)。ROC曲线显示,NLR诊断酒精性肝硬化患者合并自发性细菌性腹膜炎的效能最高,CAR居中,LMR最低。结论 上消化道出血、NLR、LMR、CAR是老年酒精性肝硬化患者合并自发性细菌性腹膜炎的影响因素,NLR、LMR、CAR均对自发性细菌性腹膜炎具有一定的诊断价值,其中以NLR的诊断效能最高。Objective To explore the influencing factors of spontaneous bacterial peritonitis and the predictive value of multiple inflammatory indicators in elderly alcoholic liver cirrhosis patients.Methods A total of 276 patients with alcoholic cirrhosis hospitalized in Beijing Friendship Hospital,Capital Medical University from January 2020 to June 2023 were selected for retrospective analysis.Seventy-two elderly patients with alcoholic cirrhosis who had spontaneous bacterial peritonitis at admission were included in the observation group,and 204 elderly patients with alcoholic cirrhosis who did not have SBP were included in the control group.The clinical data of patients in the two groups were collected by an electronic medical record system at admission.Multivariate logistic regression model was used to analyze the correlation between inflammatory factors and spontaneous bacterial peritonitis.ROC curve was used to evaluate the diagnostic efficacy of inflammatory factors for spontaneous bacterial peritonitis.Results Univariate analysis showed that the proportion of combined diabetes,hepatic encephalopathy,and upper gastrointestinal bleeding in the observation group was higher than that in the control group,prothrombin time was longer than that in the control group,neutrolphil to lymphocyte ratio(NLR)and C-reactive protein to albumin ratio(CAR)were higher than those in the control group,and lymphocyte to monocyte ratio(LMR)was lower than that in the control group,and the differences were statistically significant(P<0.05).The results of multivariate logistic regression model showed that upper gastrointestinal bleeding,NLR and CAR were independent risk factors for spontaneous bacterial peritonitis in elderly patients with liver cirrhosis(P<0.05),and LMR was a protective factor(P<0.05).ROC curves showed that NLR had the highest efficacy in diagnosing spontaneous bacterial peritonitis in ALC patients,CAR was intermediate,and LMR was the lowest.Conclusion Upper gastrointestinal bleeding,NLR,LMR and CAR are the influencing fac

关 键 词：酒精性肝硬化 自发性细菌性腹膜炎 炎症因子 诊断效能 

分 类 号：R575.2[医药卫生—消化系统]