血小板/淋巴细胞比值与细菌性肝脓肿病原学及预后相关性研究  

Correlation of platelet-lymphocyte ratio with the etiology and prognosis of bacterial liver abscess

作　　者：荣明明 颜学兵 RONG Mingming;YAN Xuebing(Department of Infectious Diseases,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院感染性疾病科,江苏徐州221000

出　　处：《安徽医药》2025年第3期555-560,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨细菌性肝脓肿(BLA)病人中血小板/淋巴细胞比值(PLR)在判断病原学特征及预后情况的临床价值。方法选取2016年1月至2021年12月于徐州医科大学附属医院住院治疗且符合细菌性肝脓肿诊断标准的BLA病人作为研究对象。分析该院BLA病人的临床特征,筛选培养阳性率最高的两种病原菌:肺炎克雷伯菌肝脓肿(KPLA)与大肠埃希菌肝脓肿(ECLA),比较KPLA与非KPLA组,ECLA与非ECLA组临床特征;根据病人预后分为好转组及非好转组,通过多因素logistic回归分析及受试者操作特征曲线(ROC曲线)探究PLR在BLA预后评估的预测价值。结果符合纳入标准的病人共660例,以男性(70.30%)为主,年龄(58.23±13.75)岁,最常见的合并症为合并糖尿病(45.91%);首位病原菌为肺炎克雷伯菌(61.00%),其次为大肠埃希菌(18.67%)。与非KPLA组比较,KPLA组PLR高(210.95±200.45比157.75±131.59),血小板低[(203.50±142.68)×10^(9)/L比(237.64±133.44)]×10^(9)/L,病人合并糖尿病多见(59.90%比41.90%),白细胞计数高[(12.67±5.04)×10^(9)/L比(11.22±5.85)×10^(9)/L](均P<0.05)。ECLA组合并胆道疾病、腹部手术史、脓肿多发比例较非ECLA组高(均P<0.05),淋巴细胞计数[(1.24±0.62)×10^(9)/L比(1.50±0.84)×10^(9)/L、血红蛋白(108.51±23.82)g/L比(117.56±19.72)g/L]较非ECLA组低(均P<0.05)。BLA病人的预后不良影响因素包括:低水平PLR、高水平白细胞计数、低水平血小板、合并胆道疾病。ROC曲线分析显示,PLR曲线下面积(0.61)最大,与CRP差异有统计学意义,对PLA预后不良的预测价值更大。结论BLA致病菌首位为肺炎克雷伯菌,其次为大肠埃希菌。KPLA病人中PLR高、血小板减少更常见,低水平PLR是BLA预后不良影响因素。Objective To explore the clinical significance of the platelet-lymphocyte ratio(PLR)in the identification of etiological characteristics and prognosis in patients with bacterial liver abscess(BLA).Methods Patients meeting the diagnostic criteria for bacterial liver abscess who were hospitalized in The Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2021 were selected as study objects.Clinical characteristics of the patients were analyzed and two clinical pathogens with the highest positive rates,Klebsiella pneumoniae liver abscess(KPLA)and Escherichia coli liver abscess(ECLA),were screened and cultured.These patients were categorized into KPLA group and non-KPLA group,ECLA and non-ECLA group,to compare their clinical characteristics.According to the prognosis of the patients,they were assigned into improvement group and non-improvement group,and the predictive value of PLR in the prognosis evaluation of BLA was explored by multivariate Logistic regression analysis and receiver operating characteristic curve(ROC curve).Results A total of 660 patients met the inclusion criteria,who were mainly males(70.30%),with an average age of(58.23±13.75)years,and the most common comorbidity was diabetes mellitus(45.91%).The most common pathogen was Klebsiella pneumoniae(61.00%),followed by Escherichia coli(18.67%).Compared with the non-KPLA group,the KPLA group had higher PLR[(210.95±200.45)vs.(157.75±131.59)],lower platelet[(203.50±142.68)×10^(9)/L vs.(237.64±133.44)×10^(9)/L],more complicated diabetes mellitus(59.90%vs.41.90%),and higher WBC[(12.67±5.04)×10^(9)/L vs.(11.22±5.85)×10^(9)/L](all P<0.05).Compared with the non-ECLA group,the ECLA group had higher rates of biliary tract disease,history of abdominal surgery,and multiple abscesses(all P<0.05),lower lymphocyte count[(1.24±0.62)×10^(9)/L vs.(1.50±0.84)×10^(9)/L],and lower hemoglobin[(108.51±23.82)g/L vs.(117.56±19.72)g/L](all P<0.05).Risk factors for poor prognosis in patients with BLA included low level of PLR,high WBC,

关 键 词：细菌性肝脓肿 肺炎克雷伯菌 大肠埃希菌 血小板 淋巴细胞 

分 类 号：R575.4[医药卫生—消化系统]