血清学血小板/白蛋白、C反应蛋白/白蛋白评估克罗恩病黏膜愈合及疾病复发的价值

Value of serum platelet/albumin and C-reactive protein/albumin ratios in evaluating mucosal healing and disease recurrence in patients with Crohn’s disease

背景目前对克罗恩病(Crohn’s disease,CD)血清学标志物的研究较多的炎症性标志物主要为C反应蛋白,但无法用单独指标进行预测,近年来有研究发现血清标志物的联合应用可更准确的进行预测,且血清血小板/白蛋白(platelet/serum albumin,PLT/ALB)、C反应蛋白/白蛋白(C-reactive protein/serum albumin,CRP/ALB)值在评估炎症活动期等方面的特异性较高.目的探讨血清学血小板/白蛋白、C反应蛋白/白蛋白评估CD黏膜愈合及疾病复发的价值.方法选取新洲区人民医院2019-04/2021-04收治的85例CD患者.根据临床及内镜下愈合标准分为黏膜愈合组(n=44)和黏膜未愈合组(n=41),比较两组患者一般资料、治疗前及治疗6 mo后血清ALB、PLT、CRP、PLT/ALB、CRP/ALB水平及与SES-CD评分的相关性分析及评估黏膜愈合的价值,根据是否复发分为复发组和未复发组,比较两组血清指标水平及血清指标预测疾病复发的价值.结果2019-04/2021-04收治的85例CD患者经过6 mo治疗后,黏膜愈合组(n=44)中ALB水平较黏膜未愈合组(n=41)显著升高,而PLT、CRP水平显著降低,且PLT/ALB、CRP/ALB指标水平均降低,差异均具有统计学意义(P<0.05),血清ALB、PLT、CRP、PLT/ALB、CRP/ALB指标与SES-CD评分有明显相关性;采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估,ALB、PLT、CRP、CRP/ALB及PLT/ALB评估黏膜愈合的ROC曲线与坐标轴形成面积(area under ROC curve,AUC)值分别为0.712、0.662、0.774、0.776、0.719(AUC>0.5);治疗6 mo后,复发组(n=45)ALB较未复发组(n=40)明显降低,而PLT、CRP、PLT/ALB、CRP/ALB水平升高,差异具有统计学意义(P<0.05);采用ROC曲线评估,ALB、PLT、CRP、CRP/ALB和PLT/ALB评估疾病复发的AUC值为0.641、0.628、0.643、0.652、0.651(AUC>0.5).结论血清学优化PLT/ALB、CRP/ALB指标在评估CD黏膜愈合及疾病复发的效果更佳,其临床价值高.

BACKGROUND At present,the most studied inflammatory markers of Crohn’s disease(CD)are C-reactive protein,but CD cannot be predicted by a single index.In recent years,studies have found that the combined application of serum markers can be more accurate for prediction,and platelet/serum albumin(PLT/ALB)and C-reactive protein/serum albumin(CRP/ALB)ratios have high specificity in evaluating inflammatory activity.AIM To explore the value of serological platelet/albumin and C-reactive protein/albumin ratios in evaluating mucosal healing and disease recurrence in patients with CD.METHODS Eighty-five patients with CD treated at Xinzhou District People’s Hospital from April 2019 to April 2021 were selected.According to the clinical and endoscopic healing criteria,the patients were divided into either a mucosal healing group or a mucosal non-healing group.The general data,serum ALB,PLT,and CRP levels,and PLT/ALB and CRP/ALB ratios were recorded before and after treatment.The correlation between serum indexes and SES-CD score was analyzed to evaluate their value in assessing mucosal healing.The patients were divided into a recurrent group and a non-recurrent group according to whether they relapsed.The value of serum indexes in predicting disease recurrence was assessed.RESULTS After 6 mo of treatment,the level of ALB in the mucosal healing group(n=44)was significantly higher than that in the mucosal non-healing group(n=41),while the levels of PLT,CRP,PLT/ALB ratio,and CRP/ALB ratio significantly decreased(P<0.05).Serum ALB,PLT,CRP,PLT/ALB ratio,and CRP/ALB ratio were significantly correlated with SES-CD score.The AUC values of ALB,PLT,CRP,CRP/ALB ratio,and PLT/ALB ratio in assessing mucosal healing were 0.712,0.662,0.774,0.776,and 0.719,respectively(all AUC values>0.5).After treatment,ALB in the recurrent group was significantly lower than that in the non-recurrent group,while the levels of PLT,CRP,PLT/ALB ratio,and CRP/ALB ratio were significantly higher in the recurrent group(P<0.05).The AUC values of ALB,PLT,CRP,CRP/ALB ratio,and PLT/ALB ratio for predicting disease recurrence were 0.641,0.628,0.643,0.652,and 0.651,respectively(all AUC values>0.5).CONCLUSION PLT/ALB and CRP/ALB ratios have high clinical value in evaluating mucosal healing and disease recurrence in patients with CD.