重症肺炎患儿的C反应蛋白/前白蛋白比值及其对患儿临床转归的评估价值

C-reactive protein/prealbumin ratio and its evaluation value on clinical outcome in children with severe pneumonia

目的分析重症肺炎患儿C反应蛋白(CRP)/前白蛋白(PA)比值,并探讨CRP/PA比值对患儿临床转归的评估价值。方法纳入105例重症肺炎患儿(重症肺炎组)及90例健康儿童(对照组),并根据治疗10 d后的临床转归将重症肺炎患儿分为好转组(59例)和恶化组(46例)。比较重症肺炎组与对照组的血清CRP、PA水平及CRP/PA比值。比较好转组与恶化组的一般资料、急性生理学及慢性健康评估Ⅱ(APACHEⅡ)评分,以及确诊当日和治疗13~15 d后血清CRP、PA水平及CRP/PA比值。采用Logistic回归模型分析重症肺炎患儿临床转归的影响因素。采用受试者工作特征(ROC)曲线分析确诊当日血清CRP、PA水平及CRP/PA比值对重症肺炎患儿临床转归的预测价值。结果与对照组相比,重症肺炎组患儿确诊当日的血清CRP水平和CRP/PA比值均升高,血清PA水平降低(均P<0.05)。恶化组患儿确诊当日的APACHEⅡ评分高于好转组(P<0.05)。治疗13~15 d后,好转组血清CRP水平和CRP/PA比值均较确诊当日降低,血清PA水平较确诊当日升高,而恶化组血清CRP水平和CRP/PA比值较确诊当日升高,血清PA水平较确诊当日降低(均P<0.05);确诊当日和治疗13~15 d后,与好转组相比,恶化组患儿血清CRP水平、CRP/PA比值升高,而血清PA水平降低(均P<0.05)。Logistic回归分析结果显示,确诊当日血清CRP水平、CRP/PA比值和APACHEⅡ评分为重症肺炎患儿临床转归的危险因素,确诊当日血清PA水平则为重症肺炎患儿临床转归的保护因素(均P<0.05)。评估重症肺炎患儿临床转归时,CRP/PA比值的敏感度和特异度均>80%,且其曲线下面积(0.917)大于血清CRP(0.743)、PA(0.792)水平(均P<0.05)。结论重症肺炎患儿的CRP/PA比值升高。CRP/PA比值对重症肺炎患儿临床转归具有一定的评估价值,该比值如进一步升高,则提示病情恶化的可能。

Objective To analyze the ratio of C-reactive protein(CRP)/prealbumin(PA)of children with severe pneumonia,and to explore the evaluation value of CRP/PA ratio on the clinical outcome of the children.Methods A total of 105 children with severe pneumonia(the severe pneumonia group)and 90 healthy children(the control group)were enrolled,and the children with severe pneumonia were further assigned to improvement group(59 cases)or deterioration group(46 cases)according to the clinical outcome after 10-day treatment.The serum CRP and PA levels,and the ratio of CRP/PA were compared between the severe pneumonia group and the control group.The general data,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,and serum CRP and PA levels,and the ratio of CRP/PA on the day of confirmed diagnosis and 13 to 15 days after treatment were compared between the improvement group and the deterioration group.The influencing factors for the clinical outcome of children with severe pneumonia were analyzed by the Logistic regression model.The predictive value of serum CRP and PA levels,and the ratio of CRP/PA on the day of confirmed diagnosis on the clinical outcome of children with severe pneumonia was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the level of serum CRP and the ratio of CRP/PA in the severe pneumonia group on the day of confirmed diagnosis elevated,whereas the level of serum PA declined(all P<0.05).On the day of confirmed diagnosis,the APACHEⅡscore in the deterioration group was higher than that in the improvement group(P<0.05).After 13 to 15 days of treatment,the serum CRP level and CRP/PA ratio in the improvement group decreased as compared with on the day of confirmed diagnosis,and the serum PA level was higher than that on the day of confirmed diagnosis,while the serum CRP level and CRP/PA ratio in the deterioration group elevated as compared with on the day of confirmed diagnosis,whereas the serum PA level was lower than that on the day of confirmed diagnosis(all P<0.05).Compared with the improvement group,the serum CRP level and CRP/PA ratio in the deterioration group increased,while the serum PA level decreased on the day of confirmed diagnosis and 13 to 15 days after treatment(all P<0.05).The results of Logistic regression analysis revealed that serum CRP level,CRP/PA ratio and APACHEⅡscore on the day of confirmed diagnosis were the risk factors for the clinical outcome of children with severe pneumonia,and the serum PA level on the day of confirmed diagnosis was the protective factor for the clinical outcome of children with severe pneumonia(all P<0.05).When evaluating the clinical outcome of children with severe pneumonia,the sensitivity and specificity of CRP/PA ratio were all>80%,and the area(0.917)under the curve was larger than those of the levels of serum CRP(0.743)and PA(0.792,all P<0.05).Conclusion The CRP/PA ratio elevates in children with severe pneumonia.The ratio of CRP/PA exerts an evaluation value on the clinical outcome of children with severe pneumonia to a certain extent.If the ratio elevates further,it indicates that the possibility of disease deterioration.