超敏C反应蛋白与白蛋白比值对慢阻肺合并肺部感染患者的诊断价值

Diagnostic Value of Hypersensitive C-reactive Protein to Albumin Ratio in Patients with Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Infection

目的探讨超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)与白蛋白(albumin,ALB)比值(hs-CRP/ALB)对慢性阻塞性肺疾病(简称慢阻肺)合并肺部感染的诊断价值。方法选取接受治疗的110例慢阻肺患者作为慢阻肺组,其中并发肺部感染患者40例(感染组),无肺部感染患者70例(未感染组),另选取同期健康体检人群110例作为对照组。同时根据慢阻肺合并肺部感染患者的预后再分为死亡组(10例)与存活组(30例)。所有纳入对象入院后均检测血清hs-CRP、ALB水平,并计算hs-CRP/ALB比值。比较各组基本资料、生化指标及hs-CRP/ALB比值情况,采用受试者工作特征(ROC)曲线评估hs-CRP/ALB比值对慢阻肺合并肺部感染的诊断价值,同时采用单因素、多因素分析影响慢阻肺合并肺部感染患者预后的相关因素。结果慢阻肺组hs-CRP、hs-CRP/ALB水平均高于对照组,ALB水平低于对照组,差异有统计学意义(P<0.05)。感染组患者血清hs-CRP及hs-CRP/ALB水平高于未感染组,ALB水平低于未感染组,差异有统计学意义(P<0.05)。ROC曲线结果显示,hs-CRP预测慢阻肺合并肺部感染的曲线下面积(AUC)为0.832,截断值60.33 mg·L-1,敏感度、特异度分别为92.7%、68.9%,ALB预测慢阻肺合并肺部感染的AUC为0.769,截断值17.26 g·L-1,敏感度、特异度分别为92.7%、55.3%,hs-CRP/ALB比值预测慢阻肺合并肺部感染的AUC为0.921,截断值2.24,敏感度、特异度分别为86.4%、85.3%。死亡组患者血清hs-CRP及hs-CRP/ALB水平高于存活组,ALB水平低于存活组,差异有统计学意义(P<0.05)。经单因素、多因素Cox回归分析显示,病程[HR(95%CI)=3.789(2.491~5.763)]、hs-CRP[HR(95%CI)=4.039(1.941~8.407)]、ALB[HR(95%CI)=3.333(2.022~5.495)]、hs-CRP/ALB比值[HR(95%CI)=4.096(2.120~7.913)]均为影响慢阻肺合并肺部感染患者预后的危险因素(P<0.05)。结论慢阻肺合并肺部感染患者hs-CRP/ALB比值高于单纯慢阻肺患者,hs-CRP/ALB比值不仅对慢阻肺合并肺部感染具有较高的诊断效能,同时与患者预后有关,对慢阻肺合并肺部感染患者的预后具有良好评估价值。

Objective To investigate the diagnostic value of hypersensitive C-reactive protein(hs-CRP)to albumin(ALB)ratio(hs-CRP/ALB)for pulmonary infections associated with chronic obstructive pulmonary disease(COPD).Methods 110 COPD cases who received treatment were selected as the COPD group,including 40 patients with concurrent pulmonary infection(infected group)and 70 patients without pulmonary infection(uninfected group),and another 110 patients in the same period of healthy physical examination population were selected as the control group.At the same time,according to the prognosis of COPD cases with pulmonary infection,they were divided into death group(n=10)and survival group(n=30).Serum hs-CRP and ALB levels were detected and hs-CRP/ALB ratio was calculated in all subjects after admission.The basic data,biochemical indexes and hs-CRP/ALB ratio of each group were compared.The diagnostic value of hs-CRP/ALB ratio for COPD patients with pulmonary infection was evaluated by ROC.The related factors affecting the prognosis of COPD cases with pulmonary infection were analyzed by using univariate and multifactorial analysis.Results The levels of hs-CRP and hs-CRP/ALB in COPD group were higher than those in control group,while the levels of ALB in COPD group were lower than those in control group,and the differences were statistically significant(P<0.05).The levels of hs-CRP and hs-CRP/ALB in the infected group were higher than those in the uninfected group,and the levels of ALB were lower than those in the uninfected group,with statistically significant differences(P<0.05).The area under the curve of hs-CRP for predicting COPD with pulmonary infection was 0.832,with a cut-off value of 60.33 mg·L-1,and the sensitivity and specificity were 92.7%and 68.9%,respectively.The area under the curve of ALB for predicting COPD with pulmonary infection was 0.769,with a cut-off value of 17.26 g·L-1,the sensitivity and specificity were 92.7%and 55.3%,respectively.The area under the curve of hs-CRP/ALB for predicting COPD with pulmonary infection was 0.921,with a cut-off value of 2.24,the sensitivity and specificity was 86.4%and 85.3%,respectively.The levels of hs-CRP and hs-CRP/ALB in the death group were higher than those in the survival group,and the levels of ALB were lower than those in the survival group(P<0.05).As shown by univariate and multifactorial Cox regression analysis,the course of disease[HR(95%CI)=3.789(2.491-5.763)],hs-CRP[HR(95%CI)=4.039(1.941-8.407)],ALB[HR(95%CI)=3.333(2.022-5.495)],hs-CRP/ALB[HR(95%CI)=4.096(2.120-7.913)]were all risk factors affecting the prognosis of COPD cases with pulmonary infection(P<0.05).Conclusion The hs-CRP/ALB ratio in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection is higher than that in patients with simple COPD.The hs-CRP/ALB ratio not only has a higher diagnostic efficacy for chronic obstructive pulmonary disease,but also correlates with patient prognosis,and has a good assessment value for the prognosis of patients with chronic obstructive pulmonary disease and pulmonary infection.