CRP与白蛋白比值对急性重症肾盂肾炎预测价值的探讨

Clinical significance of the ratio of CRP to albumin for predicting the severe acute pyelonephritis

目的观察不同严重程度肾盂肾炎患者血清C-反应蛋白、白蛋白及二者比值情况，探讨其在肾盂肾炎病情评估中的意义。方法选取2013年6月～2015年6月期间我院40例急性肾盂肾炎患者，根据重症肾盂肾炎诊断标准分为重症组（n=16）与非重症组（n=24），同时选取同时期来我院健康体检的正常人群作为正常对照组（n=50）。分别收集入院第1天患者及健康人群血清CRP、白蛋白水平、白细胞计数、血小板计数、肌酐、年龄、性别以及急性肾盂肾炎患者体温、热程、住院时间和住院费用。结果重症组患者热程、住院时间、住院费用均明显高于非重症组（P〈0．01）。重症组和非重症组患者血清CRP、白蛋白以及CRP／白蛋白比值均有显著差异（P〈0．05）；ROC曲线分析提示，CRP／白蛋白比值、CRP和白蛋白曲线下面积（AUC）分别为0．906、0．861和0．796，差异均有统计学意义（P〈0．05）；当CRP／白蛋白比值、CRP和白蛋白分别取3．0、100．0mg／L和35．0g/L为界值时，其预测重症肾盂。肾炎的灵敏度分别为87．5％、87．5％和70．5％；特异度分别为83．3％、75．0％和62．5％。结论CRP／白蛋白、CRP和白蛋白均能预测急性肾盂肾炎患者病情严重程度，其中CRP／白蛋白比值优于CRP和白蛋白。

Objective To investigate the clinical value of the ratio of serum CRP to albumin for predicting the severe acute pyelonephritis in patients with acute pyelonephritis. Methods A total of 40 patients diagnosed： with acute pyelonephritis were enrolled from June 2013 to June 2015 in this study and divided into two groups according tO the diagnostic criteria of severe acute pyelonephritis： severe group（n=16） and non-severe group（n=24）. And the health people were enrolled as a normal control group （n=50） at the same time. The serum CRP, albumin, WBC, PLT and creatinine were measured on admission day,the age, gender, temperature, fever.time, duration of hospital stays and hospitalization costs of acute pyelonephritis were collected. Results The fever time, duration of hospital stays and hospitalization costs of severe group were significantly higher than those of non-severe group（P〈0.05）. The C-reactive protein, albumin and CRP/albumin ratio were significantly different between severe group and non-severe group（P〈0.05）. Receiver operating characteristic curves showed the area under the curve of CRP/albumin ratio, CRP and albumin on admission day for predicting severe acute pyelonephritis were 0.906, 0.861 and 0.796, respectively （P〈0.05）. When the cut-off of CRP/albumin ratio, CRP and albumin were 3.0, 100.0 mg/L and 35.0 g/L respectively, the sensitivity were 87.5%, 87.5% and 70.5% respectively; the specificity were 83.3%, 75.0% and 62.5% respectively. Conclusion The CRP/albumin ratio, CRP and albumin are independent predictors of the severe acute pyelonephritis. But, the CRP/albumin ratio is better than CRP and albumin alone.