C反应蛋白对中重型颅脑创伤患者发生急性呼吸衰竭的诊断价值研究

Diagnostic value of C-reactive protein in acute respiratory failure in patients with moderate or severe traumatic brain injury

目的探究C反应蛋白(CRP)对于中重型颅脑损伤(M-STBI)发生急性呼吸衰竭(ARF)的独立危险因素及对ARF的预测价值。方法对2015年1月至2020年12月来唐都医院就诊的M-STBI患者临床资料进行回顾分析。通过单因素分析与多因素logistic回归的统计方法,从M-STBI患者的临床资料、影像学评分和实验室数据中筛选与ARF相关的危险因素,分析CRP对于ARF发生的比值比(OR)。通过受试者工作特征(ROC)曲线,分析CRP对于M-STBI诊断的最佳截断值、诊断效能(AUC)、敏感度和特异度。结果最终312例M-STBI患者纳入分析,其中发生ARF 132例。单因素分析显示,与非ARF组患者相比,ARF组患者与入院格拉斯哥昏迷评分、吸烟史、肺部渗出、影像Marshall评分、白细胞计数、中性粒细胞百分比、CRP、降钙素原均显著相关(P<0.05)。多因素logistic回归分析显示,CRP对于中型颅脑损伤患者发生ARF的OR为1.037(P=0.021),对于重型颅脑损伤的OR为1.012(P=0.020)。CRP在中型颅脑损伤患者中预测ARF的最佳截断值为13.23 mg/L、敏感度为85.7%、特异度为64.3%、AUC为0.788,而重型颅脑损伤的最佳截断值为79.69 mg/L、敏感度为66.7%、特异度为91.7%、AUC为0.792。结论CRP水平增高是M-STBI后发生ARF的独立危险因素,中型颅脑损伤(13.23 mg/L<CRP<79.69 mg/L)以及重型颅脑损伤(CRP≥79.69 mg/L)对于预测患者发生ARF具有较高的诊断效能、敏感度与特异度。

Objective To explore the correlation of C-reactive protein(CRP)with acute respiratory failure(ARF)after admission of patients with moderate or severe traumatic brain injury(M-STBI)and its predictive value.Methods We retrospectively analyzed the clinical data of adult M-STBI patients admitted to Tangdu Hospital of Air Force Medical University from January 2015 to December 2020.To find out risk factors related to ARF,the clinical data,imaging scores and laboratory data of the selected patients were analyzed by univariate analysis,and the odds ratio(OR)of CRP for ARF was analyzed by multivariate logistic regression.The optimal cutoff value,diagnostic efficiency(AUC),sensitivity and specificity of CRP for the diagnosis of M-STBI were analyzed through the receiver operating characteristic(ROC)curve.Results A total of 312 patients with M-STBI were included in the final analysis,including 132 patients with ARF.Compared with patients in non-ARF group,univariate analysis showed that ARF development was significantly correlated with Glasgow Coma Scale score at admission,smoking history,pulmonary exudation,image Marshall score,leukocyte count,percentage of neutrophils,CRP and procalcitonin(P<0.05).Multivariate logistic regression analysis showed that OR of CRP for ARF was 1.037(P=0.021)in patients with moderate TBI and 1.012(P=0.020)in severe TBI.The optimal cutoff value of CRP for predicting ARF was 13.23 mg/L,sensitivity 85.7%,specificity 64.3%,and AUC 0.788 in patients with moderate TBI,while in patients with severe TBI,the optimal cutoff value was 79.69 mg/L,sensitivity 66.7%,specificity 91.7%,and AUC 0.792.Conclusion The increase of CRP level is an independent risk factor for ARF after M-STBI.Moderate TBI(13.23 mg/L<CRP<79.69 mg/L)and severe TBI(CRP≥79.69 mg/L)have high diagnostic efficiency,sensitivity and specificity for predicting ARF.