【摘要】 目的:分析血小板-白蛋白-胆红素(PALBI)评分联合C反应蛋白/白蛋白比值(CAR)在肝硬化自发性细菌性腹膜炎(SBP)预测中的临床价值。方法:本研究为基于病历资料的回顾性分析，以2021年1月至2024年12月西安交通大学第一附属医院住院诊疗的358例肝硬化腹水患者为研究对象。根据住院期间是否发生SBP，将358例肝硬化患者分为SBP组92例(25.70%)和非SBP组266例(74.30%)。提取肝硬化患者入院后的临床资料，通过Logistic回归法评估PALBI和CAR与肝硬化患者发生SBP的相关性，并采用ROC曲线对二者预测SBP的效能进行评估。结果:组间比较显示，与非SBP组患者比较，SBP组患者PALBI评分、CAR升高，差异显著(均P<0.05)。此外，SBP组患者并发上消化道出血、肝性脑病的比例以及凝血酶原时间、降钙素原也显著升高(均P<0.05)，可能是影响SBP发生风险的混杂因素。多因素Logistic回归分析校正混杂因素后显示，PALBI评分(OR=1.692,95%CI:1.210～2.367)、CAR(OR=1.504,95%CI:1.087～2.081)是肝硬化患者住院期间发生SBP的独立危险因素。ROC曲线显示，PALBI评分联合CAR预测肝硬化患者发生SBP的AUC为0.859(95%CI:0.813～0.906)，较PALBI评分提高12.88%[AUC:0.761(95%CI:0.701～0.0. 821)]，较CAR提高20.99%[AUC:0.710(95%CI:0.647～0.722)]。结论:PALBI评分、CAR是肝硬化患者住院期间发生SBP的独立危险因素，二者联合应用对于SBP具有良好的预测效能，可为临床提供一种实用性的工具，从而早期筛查出SBP高风险人群，尤其对于基层医疗机构而言具有重要的应用价值。更多还原

【Abstract】 Objective: To analyze the clinical value of platelet-albumin-bilirubin( PALBI) score combined with C-reactive protein/albumin ratio( CAR) in the prediction of spontaneous bacterial peritonitis( SBP) in cirrhosis. Methods: This study was a retrospective analysis based on medical records data,and 358 patients with cirrhotic ascites who were hospitalized and treated in the First Affiliated Hospital of Xi’ an Jiaotong University from January 2021 to December 2024 were studied. According to whether SBP occurred during hospitalization,the 358 cirrhotic patients were divided into 92 cases( 25. 70%) in the SBP group and 266 cases( 74. 30%) in the non-SBP group. Clinical data of cirrhotic patients after hospitalization were extracted,and the correlation between PALBI and CAR and the occurrence of SBP in cirrhotic patients was assessed by logistic regression,and the efficacy of both in predicting SBP was evaluated by using ROC curves. Results: Inter-comparison showed that PALBI score and CAR were elevated in the SBP group compared with the non-SBP group,and the differences were significant( both P < 0. 05). In addition,the proportion of concomitant upper gastrointestinal bleeding and hepatic encephalopathy,as well as prothrombin time and calcitoninogen were also significantly higher in the SBP group( all P < 0. 05),which may be a confounding factor affecting the risk of developing SBP. Multifactorial logistic regression analysis corrected for confounders showed that PALBI score( OR = 1. 692,95% CI: 1. 210-2. 367) and CAR( OR = 1. 504,95% CI: 1. 087-2. 081) were independent risk factors for the development of SBP during hospitalization in cirrhotic patients. The ROC curve shows that the AUC for predicting the occurrence of SBP in cirrhosis patients using the combined PALBI score and CAR is 0. 859( 95% CI: 0. 813-0. 906),which is 12. 88% higher than the PALBI score alone [AUC: 0. 761( 95% CI: 0. 701-0. 821) ] and 20. 99% higher than CAR alone [AUC: 0. 710( 95% CI: 0. 647-0. 722) ]. Conclusion: The combination of the PALBI score and CAR is an independent risk factor for SBP in cirrhotic patients during hospitalization,and the combination of the two has good predictive performance for SBP,which can provide a practical tool for the clinic to screen out the high-risk group of SBP at an early stage,and is especially valuable for the primary healthcare organizations.更多还原