To Explore The Diagnostic Value Of Inflammation Indexes And Liver Biochemical Indexes In Acute Cholangitis

Background:Acute Cholangitis(AC)is a common infectious disease of biliary tract in China,which is often caused by bacterial infection after partial or complete obstruction of biliary tract.The clinical prognosis of different severity of AC is different.If it cannot be diagnosed and treated early,it can rapidly develop into acute suppurative cholangitis,which can lead to sepsis or multiple organ failure,and it is the main cause of death of benign biliary tract diseases.Therefore,whether acute cholangitis patients can get early and effective diagnosis and treatment is particularly important.We studied the peripheral blood neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR)and lymphocyte-monocyte ratio(LMR)of patients with acute cholangitis,and compared with the commonly used inflammatory indicators(WBC,CRP and PCT),in order to explore its correlation with disease severity and clinical application value.At the same time,we studied the diagnostic value of liver biochemical indexes for moderate and severe cholangitis by comparing the liver biochemical indexes with different degrees of AC.Both of these two aspects aimed to find more simple,rapid and economic assessing laboratory indexes.Objective:To explore the level and clinical significance of inflammation index and liver biochemical indexes in peripheral blood of patients with acute cholangitis,and to explore its diagnostic value for the severity of acute cholangitis.Methods:654 patients with acute calculous cholangitis who were hospitalized in the Department ofGastroenterology,Huaihe Hospital of Henan University from December 2017 to December 2019 were selected as subjects.In addition,240 healthy persons who underwent health examination in our hospital in the same period were randomly selected as the control group.According to the guidelines for acute cholangitis in Tokyo in 2018,the AC group was divided into mild and moderate to severe groups,and the clinical data of the patients were collected.To observe the difference of blood routine,CRP,PCT and liver biochemical indexes between AC group and control group,and to analyze the changes of serological indexes in patients with acute cholangitis of different severity.The diagnostic value of each serological index to moderate and severe cholangitis was compared by ROC curve.Results:1.Compared with the control group,the NLR and PLR of the AC group were significantly higher than the control group,and the LMR was lower than the control group,the difference was statistically significant(P <0.05);TBIL,DBIL,ALT,AST,GGT,ALP and TBA were all increased in AC group,TP and ALB decreased,and the difference was statistically significant(P <0.05).2.Compared with AC group,the NLR and the PLR in moderate and severe group were significantly higher than those in mild group,while the LMR was the highest in mild group and the lowest in moderate and severe group(P <0.05).Compared with mild group,TBIL and DBIL increased in patients with moderate to severe groups,TP and ALB decreased,and the differences were statistically significant(P <0.05).3.When predicting moderate and severe AC by single index,the areas under the curve of WBC,NLR,PLR,LMR,CRP and PCT were 0.701,0.752,0.581,0.637,0.715 and 0.751,respectively.The maximum area under NLR curve was 0.752,which was higher than other indexes such as WBC,CRP and PCT.The highest severe AC sensitivity in diagnosis is NLR,which can reach 78.40%.The specificity ofwhite blood cells for the diagnosis of moderate to severe AC is up to 94.30%,but the area under the curve is only 0.601,and the sensitivity is also low,at 47.30%;The comparison of various indexes of liver biochemical showed that the area under the curve of ALB was the largest,which was 0.851,and the sensitivity was 88.3%,and the specificity was 72.5%.4.When the combined detection of NLR,PLR and LMR was carried out,it was found that the maximum area under the curve was 0.774 during the combined detection of NLR,PLR and LMR;the highest severe AC sensitivity in diagnosis was the combination of NLR and LMR,which could reach81.40%,The highest specificity is PLR combined with LMR,which is 74.40%.5.Compared with before treatment,the serological indicators of AC patients after ERCP treatment all changed significantly,in which NLR and PLR showed a continuous downward trend on the1 st and 3rd day after operation,while LMR values showed an upward trend,and the differences were statistically significant(P <0.05).TBIL,DBIL,ALT,AST,GGT,ALP and TBA gradually decreased,the difference was statistically significant(P <0.05).TP and ALB decreased slightly,but the difference was not statistically significant(P > 0.05).Conclusion:1.In AC group,the level of NLR and PLR increased,while LMR decreased,which was related to the severity of the disease.2.Compared with CRP and PCT,NLR may be a new index to judge moderate and severe AC.3.The combined detection of NLR,PLR and LMR can improve the diagnostic value of moderate and severe cholangitis,which may be helpful for clinical diagnosis and treatment.4.In AC group,the level of TP increased and ALB decreased,which was related to the severity of the disease.