肝硬化并发自发性细菌性腹膜炎患者CRP/PA水平及其诊断价值  

Diagnostic value of CRP/PA in patients complicated with liver cirrhosis spontaneous bacterial peritonitis

作　　者：席德扬 陈思远 王佳露 颜学兵 李春杨 XI Deyang;CHEN Siyuan;WANG Jialu;YAN Xuebing;LI Chunyang(Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,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221002

出　　处：《中华医院感染学杂志》2025年第4期507-512,共6页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2018ZX10302206-003-010);江苏省研究生科研与实践创新基金资助项目(KYCX24_3067)。

摘　　要：目的 基于倾向性评分匹配法分析C-反应蛋白(CRP)/前白蛋白(PA)比(CRP/PA)在肝硬化腹水患者并发自发性细菌性腹膜炎(SBP)中的诊断价值。方法 选取2017年1月-2023年2月于徐州医科大学附属医院就诊的179例肝硬化腹水患者为研究对象。收集患者临床资料,计算CRP/PA。绘制匹配前受试者工作(ROC)曲线,根据最佳截断值将患者分为高CRP/PA组(87例)和低CRP/PA组(92例)。采用1:1倾向性匹配得分,控制两组混杂因素,得到两组资料均衡的样本。通过匹配后单因素和多因素逻辑回归分析肝硬化腹水患者发生SBP的危险因素。绘制匹配后ROC曲线判断CRP/PA的诊断价值。结果 179例肝硬化腹水患者,其中发生SBP患者81例。匹配前ROC曲线分析结果显示,CRP/PA诊断肝硬化腹水患者SBP发生的ROC曲线下面积(AUC)为0.960(95%CI:0.926~0.982),灵敏度为94.00%,特异度为89.00%,最佳截断值为396.64。采用1:1倾向性匹配得分共成功匹配35对,匹配后两组资料均衡。匹配后结果显示,总蛋白和CRP/PA是肝硬化腹水患者发生SBP的危险因素。匹配后ROC曲线结果显示,CRP/PA的AUC为0.944(95%CI:0.888~1.000)远大于终末期肝病模型(MELD)评分0.532(95%CI:0.396~0.669)和纤维化-4 (FIB-4)0.553(95%CI:0.412~0.694)。结论 CRP/PA作为一种新型的指标,用于评估肝硬化腹水患者发生SBP具有较高的诊断价值。OBJECTIVE To analyze the diagnostic value of the C-reactive protein/prealbumin ratio(CRP/PA)in pa-tients with liver cirrhosis and ascites complicated with spontaneous bacterial peritonitis(SBP)by propensity score-matching(PSM)method.METHODS Totally 179 patients with liver cirrhosis and ascites treated at the Affiliated Hospital of Xuzhou Medical University from Jan.2017 to Feb.2023 were selected.Clinical data were collected,and CRP/PA was calculated for each patient.The optimal cut-off value,determined by pre-matched receiver oper-ating characteristic(ROC)curve,categorized patients into the high CRP/PA group(n=87)and the low CRP/PA group(n=92).A 1:1 propensity score-matching method was used to control the confounding bias of ensuring comparability between the two groups.Univariate and multivariate logistic regression analyses were conducted to identify risk factors for SBP in cirrhotic patients with ascites.Post-matching ROC curves were plotted to evaluate the diagnostic accuracy of CRP/PA.RESULTS Among the 179 patients,81 patients were complicated with SBP.The pre-matched area under the ROC curve(AUC)of CRP/PA for diagnosing SBP in cirrhotic patients with ascites was 0.960(95%CI:0.926-0.982),with the sensitivity of 94.00%and specificity of 89.00%,and an optimal cutoff value of 396.64.A total of 35 pairs of patients were successfully matched by 1:1 propensity score matching and the informa-tions of the two groups were balanced.Post-matching analysis showed that total protein and CRP/PA were independent risk factors for SBP,and the AUC of CRP/PA was 0.944(95%CI:0.888-1.000),significantly higher than the model for end-stage liver disease(MELD)score of 0.532(95%CI:0.392-0.669)and fibrosis-4(FIB-4)score index of 0.553(95%CI:0.412-0.694).CONCLUSION CRP/PA,as a novel index with high diagnostic value,can be used to as-sess the occurrence of SBP in cirrhotic patients with ascites.

关 键 词：倾向性评分匹配 肝硬化 腹水 自发性细菌性腹膜炎 诊断价值 

分 类 号：R656.41[医药卫生—外科学]