C反应蛋白对血友病A患者急性关节出血的预测价值

Predictive value of C-reactive protein for acute joint bleeding in patients with hemophilia A

目的探讨C反应蛋白(CRP)对血友病A患者急性关节出血的预测价值。方法回顾性选取2017年5月至2021年4月在惠州市第三人民医院肿瘤血液科住院治疗的血友病A患者93例作为研究对象,根据患者是否存在急性关节出血将其分为合并急性关节出血组(n=74)和无急性关节出血组(n=19),并比较两组患者CRP水平的差异。采用多因素Logistic回归分析CRP水平与急性关节出血的关联,并通过受试者工作特征(ROC)曲线进一步评价CRP对血友病A患者急性关节出血的预测价值。结果在所研究的血友病A住院治疗患者中,平均年龄为(18.8±6.9)岁,均为男性,49.5%为重型,10.8%有接受规律的出血预防治疗,48.4%有既往关节出血史。19例患者合并急性关节出血,74例患者无急性关节出血,两组患者在年龄、身体质量指数、出血预防治疗、血红蛋白、白细胞上差异无统计学意义(P均>0.05)。尽管合并急性关节出血的患者具有血友病家族史的比例更低(26.3%vs.37.8%),且重型血友病A的比例更高(52.6%vs.48.6%),但差异并无统计学意义(P均>0.05)。合并急性关节出血的患者比无急性关节出血患者具有显著更高的CRP水平,差异有统计学意义[(27.3±9.7)mg/L vs.(20.5±10.2)mg/L,P=0.011]。在利用多因素Logistic回归分析校正其他指标后,CRP水平与合并急性关节出血显著相关(OR=1.09,95%CI:1.02~1.16,P=0.011),相应的ROC曲线下面积为0.686(95%CI:0.553~0.819)。结论CRP对血友病A患者合并急性关节出血具有一定的预测价值,高CRP提示血友病A患者可能存在急性关节出血。

【Objective】To explore the predictive value of C-reactive protein(CRP)for acute joint bleeding in patients with hemophilia A.【Methods】We retrospectively selected 93 patients with hemophilia A who were hospitalized in the Department of Oncology and Hematology of Huizhou Third People's Hospital from May 1,2017 to April 30,2021,and classified them as patients with(n=74)or without acute joint bleeding(n=19).CRP levels between the two groups were compared,and multivariate Logistic regression was used to analyze the association between CRP levels and acute joint bleeding.The receiver operating characteristic(ROC)curve analysis was used to further evaluate the predictive value of CRP for acute joint bleeding in patients with hemophilia A.【Results】Among the hospitalized patients with hemophilia A,the mean age was 18.8±6.9 years,and were all male.49.5%of the patients were severe,10.8%received regular prophylactic treatment,and 48.4%had previous history of joint bleeding.Nineteen patients had acute joint bleeding,and 74 patients did not.There was no statistically significant difference between the two groups in age,body mass index,prophylactic treatment,hemoglobin,and white blood cells(all P>0.05).Although patients with acute joint bleedings had a lower proportion of family history of hemophilia(26.3%vs.37.8%),but higher proportion of severe hemophilia A(52.6%vs.48.6%),the difference was not statistically significant(all P>0.05).Patients with acute joint bleeding had significantly higher CRP levels than those without acute joint bleeding(27.3±9.7 mg/L vs.20.5±10.2 mg/L,P=0.011).After adjusting for other characteristics by multivariable logistic regression,CRP levels were significantly correlated with acute joint bleeding(odds ratio 1.09,95%confidence interval 1.02-1.16,P=0.011),and the corresponding area under the ROC curve was 0.686(95%confidence interval 0.553-0.819).【Conclusion】CRP has certain predictive value for acute joint bleeding in patients with hemophilia A.High CRP indicates that patients with hemophilia A may have acute joint bleeding.