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

熊飞翔; 孟培培; 江宇泳; 张琴; 姜艳丹; 段浩鑫; 赵赛赛

doi:10.3969/j.issn.1001-5256.2023.08.017

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

DOI: 10.3969/j.issn.1001-5256.2023.08.017

熊飞翔^{1, 2},
孟培培¹,
江宇泳^1, , ,,
张琴²,
姜艳丹²,
段浩鑫²,
赵赛赛²

1.
首都医科大学附属北京地坛医院中西医结合中心, 北京 100015
2.
北京中医药大学东直门医院研究生院, 北京 100700

基金项目:

首都卫生科研发展专项 (2020-2-2172);

国家中医药管理局中医肝病重点专科

伦理学声明：本研究方案于2022年11月20日由北京地坛医院伦理委员会审批，批号：京地伦科字〔2020〕-第(032)-02号，患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：江宇泳对研究的思路设计，论文审阅等有关键贡献；熊飞翔参与了研究的设计、数据的分析解释过程及撰写文章关键部分；孟培培负责临床病例收集与判断；张琴、姜艳丹、段浩鑫、赵赛赛参与了研究的数据收集。熊飞翔和孟培培对本文贡献等同，同为第一作者。

详细信息

通信作者:
江宇泳，jyuy11@126.com (ORCID: 0000-0002-6082-1180)

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出版历程
- 收稿日期: 2022-10-25
- 录用日期: 2022-12-05
- 出版日期: 2023-08-20

Clinical value of C-reactive protein/albumin ratio in the diagnosis of alcoholic cirrhosis with spontaneous bacterial peritonitis

1.
Department of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
2.
Graduate School, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China

Research funding:

Capital Health Research and Development Project (2020-2-2172);

The State Administration of Traditional Chinese Medicine Key Specialty of Liver Disease

More Information

Corresponding author: JIANG Yuyong, jyuy11@126.com (ORCID: 0000-0002-6082-1180)

摘要

摘要: 目的分析C反应蛋白/白蛋白比值(CAR)判断酒精性肝硬化(ALC)患者是否合并自发性细菌性腹膜炎(SBP)的临床价值。方法回顾性选取2020年8月—2022年2月首都医科大学附属北京地坛医院住院的ALC患者329例，根据入院时是否合并SBP分为ALC未合并SBP组(n=246)和ALC合并SBP组(n=83)，比较两组患者的性别、年龄、合并症、并发症、血常规、肝肾功能、血脂和凝血指标。符合正态分布的计量资料两组间比较采用成组t检验；不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。多因素二元Logistic回归分析判断发生SBP的危险因素，绘制CAR的受试者工作特征曲线(ROC)，计算曲线下面积(AUC)、最佳截断值和95%CI。结果合并SBP患者的WBC、中性粒细胞、中性粒细胞/淋巴细胞比值、单核细胞、C反应蛋白(CRP)、CAR等炎性指标水平均高于未合并SBP患者，前者的AST、TBil、INR、MELD评分高于后者，而Alb、HDL水平显著低于后者(P值均＜0.05)。多因素Logistic回归分析发现CAR(OR=20.628，95%CI: 6.720~74.052，P＜0.01)、RBC(OR=0.600，95%CI: 0.381~0.932，P=0.025)是判断ALC患者是否合并SBP的独立危险因素。与NLR(AUC=0.725)、WBC(AUC=0.651)相比，CAR的AUC(AUC=0.825)明显较高。CAR的最佳截断值为0.324，分组后显示高风险组合并SBP的比例是63.2%(55/87)，显著高于低风险组的11.6%(28/242)(χ²=90.495，P＜0.01)。结论 CAR是判断ALC患者发生SBP的良好标志物。
- C反应蛋白/白蛋白比值 /
- 肝硬化, 酒精性 /
- 自发性细菌性腹膜炎
Abstract: Objective To investigate the clinical value of C-reactive protein/albumin ratio (CAR) in determining spontaneous bacterial peritonitis (SBP) in patients with alcoholic cirrhosis (ALC). Methods A retrospective analysis was performed for 329 ALC patients with SBP who were hospitalized in Beijing Ditan Hospital, Capital Medical University, from August 2020 to February 2022, and according to the presence or absence of SBP on admission, they were divided into non-SBP group with 246 patients and SBP group with 83 patients. The two groups were compared in terms of sex, age, comorbidities, complications, blood routine, liver and renal function, blood lipids, and coagulation markers. The independent-samples t test was used for comparison of normally distributed quantitative data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed quantitative data between two groups; the chi-square test was used for comparison of qualitative data between two groups. A multivariate binary logistic regression analysis was used to identify the risk factors for SBP. The receiver operating characteristic (ROC) curve was plotted for CAR to calculate the area under the ROC curve (AUC), the optimal cut-off value, and 95% confidence interval (CI). Results Compared with the non-SBP patients, the SBP patients had significantly higher inflammatory indicators (WBC, neutrophils, NLR, monocytes, C-reactive protein, and CAR), significantly higher aspartate aminotransferase, total bilirubin, international normalized ratio, and MELD score, and significantly lower levels of albumin and high-density lipoprotein (all P < 0.05). The multivariate logistic regression analysis showed that CAR (odds ratio [OR]=20.628, 95%CI: 6.720-74.052, P < 0.01) and red blood cell count (OR=0.600, 95%CI: 0.381-0.932, P=0.025) were independent risk factors for determining SBP in ALC patients. CAR had a significantly larger AUC than NLR and WBC (0.825 vs 0.725/0.651) and an optimal cut-off value of 0.324. The patients were divided into high-risk group and low-risk group, and the analysis showed that the high-risk group had a significantly higher proportion of patients with SBP than the low-risk group [63.2% (55/87) vs 11.6%(28/242), χ²=90.495, P < 0.01]. Conclusion CAR is a good marker for determining SBP in patients with ALC.
- CRP/Alb Ratio /
- Liver Cirrhosis, Alcoholic /
- Spontaneous Bacterial Peritonitis

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图 1 CAR与其他炎症指标诊断ALC合并SBP患者的ROC曲线

Figure 1. ROC of ALC patients combined with SBP diagnosed by CAR and other inflammatory markers

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表 1 两组患者一般资料的基线水平

Table 1. Baseline characters in two groups

项目	ALC未合并SBP组 (n=246)	ALC合并SBP组 (n=83)	统计值	P值
性别[例(%)]			χ²=0.061	0.804
女	3(1.2)	2(2.4)
男	243(98.8)	81(97.6)
年龄(岁)	57.0(31.0~76.0)	55.0(24.0~78.0)	Z=-0.505	0.614
吸烟史[例(%)]			χ²=0.193	0.661
否	53(21.5)	16(19.3)
是	193(78.5)	67(80.7)
高血压[例(%)]			χ²=0.232	0.630
否	174(70.7)	61(73.5)
是	72(29.3)	22(26.5)
糖尿病[例(%)]			χ²=0.781	0.377
否	165(67.1)	60(72.3)
是	81(32.9)	23(27.7)
腹水[例(%)]			χ²=20.561	＜0.001
否	80(32.5)	6(7.2)
是	166(67.5)	77(92.8)
消化道出血[例(%)]			χ²=6.415	0.011
否	199(80.9)	56(67.5)
是	47(19.1)	27(32.5)
肝性脑病[例(%)]			χ²=1.677	0.195
否	218(88.6)	69(83.1)
是	28(11.4)	14(16.9)
WBC(×10⁹/L)	3.81(0.92~23.60)	4.81(1.12~17.70)	Z=-4.104	＜0.001
NE(×10⁹/L)	2.31(0.45~17.50)	3.36(0.60~14.80)	Z=-5.121	＜0.001
LY(×10⁹/L)	0.96(0.16~4.36)	0.85(0.20~3.47)	Z=-0.929	0.353
NLR	2.50(0.47~23.10)	4.59(0.62~24.50)	Z=-6.142	＜0.001
MO(×10⁹/L)	0.36(0.08~1.96)	0.46(0.11~1.63)	Z=-2.414	0.016
LMR	2.41(0.67~8.43)	1.82(0.40~7.81)	Z=-4.103	＜0.001
RBC(×10⁹/L)	3.41±0.87	2.78±0.84	t=5.689	＜0.001
Hb(g/L)	103.0±29.5	89.0±27.3	t=3.888	＜0.001
PLT(×10⁹/L)	80.0(18.0~366.0)	79.0(33.0~501.0)	Z=-0.612	0.541
K(mmol/L)	3.65(1.56~31.50)	3.71(2.54~5.98)	Z=-1.196	0.232
Na(mmol/L)	141.3(139.4~142.9)	138.8(135.2~142.6)	Z=-3.643	＜0.001
Cr(μmol/L)	70.2(40.3~492.0)	77.7(24.3~554.0)	Z=-0.815	0.416
ALT(U/L)	20.1(4.7~609.0)	21.6(1.9~496.0)	Z=-0.197	0.844
AST(U/L)	30.2(10.8~425.0)	38.0(7.8~317.0)	Z=-2.654	0.008
TBil(μmol/L)	25.3(2.4~255.0)	36.7(3.7~304.0)	Z=-2.461	0.014
Alb(g/L)	32.80±5.72	28.30±4.62	t=6.504	＜0.001
HDL(mmol/L)	0.91(0.08~1.99)	0.59(0.07~1.88)	Z=-6.638	＜0.001
LDL(mmol/L)	1.74(0.22~5.85)	1.58(0.42~5.13)	Z=-1.274	0.203
CRP(mg/L)	2.6(0.0~36.7)	13.5(0.4~141.0)	Z=-8.435	＜0.001
CAR	0.08(0.00~1.51)	0.52(0.01~7.76)	Z=-8.855	＜0.001
PT(s)	14.5(9.7~30.8)	15.5(10.9~32.7)	Z=-3.364	＜0.001
INR	1.34(0.46~12.70)	1.47(1.01~3.03)	Z=-3.201	0.001
MELD评分(分)	2.62(-9.35~27.20)	5.37(-4.03~24.40)	Z=-3.204	0.001
注：LY，淋巴细胞。

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表 2 多因素Logistic回归分析结果

Table 2. Multivariate Logistic regression results

指标	OR	95%CI	P值
消化道出血(是= 1，否=0)	1.470	0.664~3.205	0.336
腹水(是=1，否=0)	2.681	1.014~8.316	0.062
WBC	0.987	0.872~1.109	0.831
NLR	1.065	0.945~1.195	0.286
RBC	0.600	0.381~0.932	0.025
Na	0.991	0.965~1.019	0.484
AST	1.002	0.993~1.010	0.629
TBil	0.997	0.989~1.005	0.465
CAR	20.628	6.720~74.052	＜0.001
HDL	0.412	0.116~1.376	0.158
INR	1.083	0.382~1.704	0.965

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