细菌性肝脓肿导致脓毒症的危险因素分析

付宽; 段美丽; 王国兴

doi:10.16766/j.cnki.issn.1674-4152.002937

细菌性肝脓肿导致脓毒症的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002937

1.
首都医科大学附属北京友谊医院急诊科，北京 100050
2.
首都医科大学附属北京友谊医院重症医学科

基金项目:

北京市医管局临床医学发展专项扬帆计划 ZYLX201804

详细信息

通讯作者:
王国兴，E-mail: 13520240749@163.com

中图分类号: R657.33 R631
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- 被引次数: 0
出版历程
- 收稿日期: 2023-01-05
- 网络出版日期: 2023-05-31

Risk factors for sepsis caused by pyogenic liver abscess

1.
Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

摘要

摘要: 目的分析细菌性肝脓肿（PLA）患者的临床特征，确定PLA导致脓毒症的危险因素以及早期诊断的化验指标。方法回顾性分析2019年1月—2020年12月于首都医科大学附属北京友谊医院诊断为细菌性肝脓肿住院患者（131例）的临床资料。将符合入组标准的患者分为脓毒症组（45例）与非脓毒症组（86例）。采用SPSS 26.0统计学软件分析2组患者的临床资料，通过单因素和logistic多因素分析明确PLA导致脓毒症的危险因素。运用受试者工作特征曲线（ROC曲线）分析入院时血中性粒细胞比值、肌酐、葡萄糖对细菌性肝脓肿进展为脓毒症的诊断价值。结果脓毒症组的男性及出现寒战症状的比例更高，且入院时的中性粒细胞百分比、血红蛋白、C-反应蛋白、谷丙转氨酶、总胆红素、直接胆红素、肌酐、葡萄糖水平高于非脓毒症组，而血小板、钠、二氧化碳水平低于非脓毒症组（均P < 0.05）。Logistic回归分析得出入院时较高的中性粒细胞百分比、肌酐、葡萄糖为细菌性肝脓肿引起脓毒症的危险因素（均P < 0.05）。ROC曲线分析示入院时血中性粒细胞比值、肌酐对于PLA进展为脓毒症的诊断价值较好。AUC值分别为0.815（95% CI: 0.743~0.886）、0.760（95% CI: 0.667~0.854）。当中性粒细胞比值≥85.8%，肌酐≥79.75 μmol/L时，需警惕PLA进展为脓毒症。结论中性粒细胞比值对于PLA导致脓毒症有较好的预测作用。对于PLA患者，中性粒细胞比值≥85.8%时需警惕病情进展为脓毒症。
- 细菌性肝脓肿 /
- 脓毒症 /
- 危险因素 /
- 中性粒细胞百分比
Abstract: Objective To analyze the clinical characteristics of pyogenic liver abscess (PLA), to review the risk factors for sepsis caused by pyogenic liver abscess (PLA) and the laboratory indicators that can predict the occurrence of sepsis at an early stage. Methods The clinical data of 131 patients with PLA in Beijing Friendship Hospital, Capital Medical University from January 2019 to December 2020 were retrospectively analyzed. Patients meeting the inclusion criteria were divided into a sepsis group (45 cases) and a non-sepsis group (86 cases). SPSS 26.0 statistical software was used to analyze the clinical data of patients in the two groups, and the risk factors of sepsis caused by PLA were determined by univariate and logistic multivariate analysis. Receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of neutrophil ratio, serum creatinine and glucose on admission for the sepsis caused by PLA. Results The sepsis group had a higher percentage of males and symptoms of chills, and higher neutrophil percentage, hemoglobin, C-reactive protein, glutamic-pyruvic transaminase, total bilirubin, direct bilirubin, creatinine and glucose levels on admission than the non-sepsis groups, while platelets, sodium and carbon dioxide levels were lower than the non-sepsis group (all P < 0.05). Logistic regression analysis showed that the higher percentage of neutrophil, creatinine and glucose at admission were the risk factors for sepsis caused by bacterial liver abscess (all P < 0.05). ROC curve analysis showed that serum neutrophil ratio and creatinine at admission had better diagnostic value for PLA progressing to sepsis, and the AUC values were 0.815 (95% CI: 0.743-0.886) and 0.760 (95% CI: 0.667-0.854), respectively. When the neutrophil ratio is ≥85.8% and creatinine ≥79.75 μmol/L, one needs to be alert for the progression of PLA to sepsis. Conclusion The neutrophil ratio is a good predictor of PLA-induced sepsis. In PLA patients, if the neutrophil ratio is ≥85.8% on admission, it is necessary to prevent the progression of sepsis.
- Pyogenic liver abscess /
- Sepsis /
- Risk factors /
- Percentage of neutrophils

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图 1 血GR%、Cr、Glu预测脓毒症发生的ROC曲线

Figure 1. The ROC curve of serum GR%, Cr and Glu in predicting sepsis

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表 1 2组细菌性肝脓肿患者一般资料及各项指标比较

Table 1. Comparation of the general information and each index between two groups of patients with bacterial liver abscess

组别	例数	性别(男/女，例)	年龄[M(P₂₅, P₇₅)，岁]	高血压[例(%)]	糖尿病[例(%)]	冠心病[例(%)]	胆结石[例(%)]	脑梗死[例(%)]	发热[例(%)]	寒战[例(%)]	腹痛[例(%)]	恶心[例(%)]
脓毒症	45	32/13	60.00(40.50，65.50)	16(35.6)	23(51.1)	1(2.2)	11(24.4)	7(15.6)	44(97.8)	42(93.3)	22(48.9)	21(46.7)
非脓毒症	86	45/41	61.00(51.00, 68.25)	38(44.2)	37(43.0)	7(8.1)	22(25.6)	6(7.0)	84(97.7)	65(75.6)	44(51.2)	30(34.9)
统计量		4.303^a	0.904^b	0.908^a	0.778^a	0.920^a	0.020^a	1.567^a	<0.001^a	5.092^a	0.061^a	1.725^a
P值		0.038	0.366	0.341	0.378	0.338	0.887	0.211	1.000	0.024	0.805	0.189

组别	例数	腹泻[例(%)]	WBC[M(P₂₅, P₇₅)，×10⁹/L]		GR% [M(P₂₅, P₇₅)]	HGB(x±s，g/L)		PLT[M(P₂₅, P₇₅)，×10⁹/L]	CRP(x±s，mg/L)		血钠(x±s，mmol/L)	ALB(x±s，g/L)
脓毒症	45	7(15.6)	13.13(8.11, 15.68)		89.30(86.80, 93.90)	131.09±18.44		168.00(103.50, 255.00)	204.95±82.59		131.79±4.43	33.96±6.52
非脓毒症	86	7(8.1)	10.47(8.21, 13.39)		81.30(75.38, 87.35)	124.14±19.63		270.00(169.75, 375.50)	144.21±75.88		135.42±4.14	35.37±4.56
统计量		1.702^a	1.549^b		5.901^b	2.164^c		4.067^b	4.220^c		4.655^c	1.294^c
P值		0.192	0.121		<0.001	0.032		<0.001	<0.001		<0.001	0.200

组别	例数	ALT[M(P₂₅, P₇₅)，U/L]	TB[M(P₂₅, P₇₅)，μmol/L]		DB[M(P₂₅, P₇₅)，μmol/L]	Cr[M(P₂₅, P₇₅)，μmol/L]		CO₂(x±s，mmol/L)	Glu[M(P₂₅, P₇₅)，mmol/L]		脓肿是否单发[例(%)]	直径>5 cm[例(%)]
脓毒症	45	57.00(33.00, 133.50)	24.74(19.34, 56.43)		15.99(9.18, 27.68)	90.50(67.65, 140.55)		21.25±4.48	13.17(7.51, 20.71)		27(60.0)	25(55.6)
非脓毒症	86	44.50(29.00, 71.75)	16.31(10.81, 25.94)		7.16(4.87, 13.04)	66.85(54.65, 77.50)		23.65±3.20	8.08(6.08, 12.39)		61(70.9)	49(57.0)
统计量		2.118^b	4.457^b		4.963^b	4.886^b		3.321^c	3.574^b		1.801^a	0.024^a
P值		0.034	<0.001		<0.001	<0.001		0.001	<0.001		0.206	0.876
注：^a为χ²值，^b为Z值，^c为t值。

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表 2 影响脓毒症的logistic回归分析

Table 2. Logistic regression analysis of influence on sepsis

变量	B	SE	Wald χ²	P值	OR(95%CI)
GR%	0.127	0.044	8.398	0.004	1.136(1.042~1.238)
Cr	0.031	0.010	10.108	0.001	1.032(1.012~1.052)
Glu	0.107	0.041	6.735	0.009	1.113(1.027~1.207)

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