血清C反应蛋白/白蛋白比值对克罗恩病临床活动度的评估价值

Evaluation value of serum C-reactive protein/albumin ratio on clinical activity of Crohn's disease

目的探究血清C反应蛋白/白蛋白比值(CRP/Alb)对克罗恩病(CD)临床活动度的评估价值。方法选取2020年1月—2022年5月于武汉大学人民医院消化内科就诊的CD患者137例纳入研究,根据简化克罗恩病活动指数(CDAI)将患者分为活动期组65例和缓解期组72例,比较2组临床资料及CRP、Alb、CRP/Alb水平差异。采用Spearman相关分析评估血清CRP、Alb、CRP/Alb水平与简化CDAI的相关性;采用二元Logistic回归分析影响CD临床活动度的独立危险因素;应用受试者工作特征曲线(ROC)分析血清CRP、Alb、CRP/Alb水平评估CD临床活动度的价值。结果活动期组CD患者CRP、CRP/Alb、红细胞沉降率(ESR)、血小板计数(PLT)明显高于缓解期组(U=6.239、6.519、3.566、3.227,P均<0.001),而Alb、淋巴细胞计数(LYM)、血红蛋白(Hb)、红细胞平均体积(MCV)、红细胞比积(HCT)均低于缓解期组(t/P=5.666/<0.001、3.796/<0.001、4.900/<0.001、2.567/0.010、5.410/<0.001)。Spearman相关性分析显示,CRP、CRP/Alb与简化CDAI呈正相关(rs=0.535、0.559,P均<0.001),而Alb与简化CDAI呈负相关(rs=-0.486,P<0.001)。二元Logistic回归分析显示,CRP/Alb高是CD临床活动度的独立危险因素[OR(95%CI)=2.959(1.190~7.363)],Alb高是其保护因素[OR(95%CI)=0.902(0.821~0.990)];ROC曲线分析显示,血清CRP、CRP/Alb及三者联合预测CD临床活动度的曲线下面积(AUC)分别为0.809、0.823、0.837,三者联合预测效能高于单项指标预测(Z=8.379、9.111、9.826,P均<0.001)。结论血清CRP/Alb比值与CD临床活动度有一定的相关性,可作为CD临床活动度评价的生物标志物。

Objective To explore the value of serum C-reactive protein/albumin ratio(CRP/Alb)in evaluating the clinical activity of Crohn's disease(CD).Methods One hundred and thirty-seven CD patients who visited the Department of Gastroenterology,People's Hospital of Wuhan University from January 2020 to May 2022 were selected to be included in the study.According to the simplified Crohn's disease activity index(CDAI),the patients were divided into 65 patients in the active phase group and 72 patients in the remission phase group.The clinical data and CRP,Alb,CRP/Alb levels of the two groups were compared.Using Spearman correlation analysis to evaluate the correlation between serum CRP,Alb,CRP/Alb levels and simplified CDAI;Using binary logistic regression analysis to identify independent risk factors affecting CD clinical activity;The value of using receiver operating characteristic curve(ROC)to analyze serum CRP,Alb,and CRP/Alb levels in evaluating clinical activity of CD.Results The CRP,CRP/Alb,erythrocyte sedimentation rate(ESR),platelet count(PLT)of CD patients in the active phase group were significantly higher than those in the remission phase group(U=6.239,6.519,3.566,3.227,P<0.001),while Alb,lymphocyte count(LYM),hemoglobin(Hb),mean corpuscular volume(MCV),and hematocrit(HCT)were lower than those in the remission phase group(t/P=5.666/<0.001,3.796/<0.001,4.900/<0.001,2.567/0.010,5.410/<0.001).Spearman correlation analysis showed that CRP,CRP/Alb were positively correlated with simplified CDAI(r s=0.535,0.559,P<0.001),while Alb was negatively correlated with simplified CDAI(r s=-0.486,P<0.001).Binary logistic regression analysis showed that high CRP/Alb was an independent risk factor for CD clinical activity[OR(95%CI)=2.959(1.190-7.363)],and high Alb was a protective factor[OR(95%CI)=0.902(0.821-0.990)];ROC curve analysis showed that the area under the curve(AUC)of serum CRP,CRP/Alb,and their combined prediction of CD clinical activity were 0.809,0.823,and 0.837,respectively.The combined prediction efficiency of the three indicators was higher than that of single indicator prediction(Z=8.379,9.111,9.826,P<0.001).Conclusion The serum CRP/Alb ratio has a certain correlation with CD clinical activity,and can be used as a biomarker for evaluating CD clinical activity.