CAR与FAR联合检测对AECOPD患者预后的评估价值

Clinical significance of combined detection of CAR and FAR in the prognosis of AECOPD

目的探讨C-反应蛋白(CRP)/白蛋白(ALB)比值(CAR)、纤维蛋白原(FIB)/白蛋白(ALB)比值(FAR)联合检测对慢性阻塞性肺疾病急性加重期(AECOPD)患者预后的评估价值。方法选取AECOPD住院患者260例,收集患者性别、年龄、体质量指数(BMI)、是否吸烟、是否合并高血压、冠心病、糖尿病基础病、是否并发肺心病等一般资料,抽取患者入院24 h内外周静脉血检测白细胞计数(WBC)、中性粒细胞百分比(N%)、ALB、CRP、FIB及血沉(ESR),并计算CAR和FAR;抽取患者入院时(未吸氧状态下)股动脉或桡动脉血,采用血气分析仪测定动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、动脉血酸碱度(pH);收集患者住院期间吸入支气管扩张后肺功能检查,采用肺功能测定仪测定第1秒用力呼气量(FEV_(1))占用力肺活量(FVC)的百分比(FEV_(1)/FVC)、FEV_(1)占预计值的百分比(FEV_(1)%pred);患者出院后均随访6个月,采用二元logistic单因素及多因素回归分析筛选出影响AECOPD患者预后的危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)评定CAR联合FAR对AECOPD患者预后的预测价值。结果预后不良组AECOPD患者WBC、N%、ESR、CRP、FIB、CAR、FAR、PaCO_(2)高于预后良好组,BMI、ALB、FEV_(1)/FVC、FEV_(1)%pred低于预后良好组,差异均有统计学意义(P<0.05);二元logistic单因素回归分析结果显示,WBC、N%、ESR、CAR、FAR、PaCO_(2)、BMI、FEV_(1)/FVC、FEV_(1)%pred均为影响AECOPD患者预后不良的危险因素;二元logistic多因素回归分析表明,WBC、CAR、FAR、PaCO_(2)及FEV_(1)%pred是AECOPD患者预后不良的独立危险因素;CAR、FAR单项及联合应用预测AECOPD预后不良的AUC分别为0.811、797、0.820,敏感度分别为0.742、0.675、0.550,特异度分别为0.771、0.829、0.950。结论CAR与FAR联合预测AECOPD患者预后的效能优于单项指标,可作为临床评估AECOPD患者预后的重要依据。

Objective To investigate the clinical significance of combined testing of C-reactive protein(CRP)/albumin(ALB)ratio(CAR),and fibrinogen(FIB)/albumin ratio(FAR)on the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 260 inpatients with AECOPD were selected as the subjects,and general data of the patients were collected(including gender,age,body mass index(BMI),smoking status,complicating hypertension,coronary heart disease,diabetes underlying disease,and pulmonary heart disease).Peripheral and internal venous blood samples were collected 24 hours after admission for white blood cell count(WBC),neutrophil percentage(N%),ALB,CRP,FIB,and erythrocyte sedimentation rate(ESR),and CAR and FAR were calculated.Femoral artery or radial artery blood was collected from the patients at admission(in unoxygenated state),and arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2))and arterial pH were measured by blood gas analyzer.Pulmonary function tests were made after inhalation bronchiectasis during hospitalization,and the percentage of forced expiratory volume(FEV_(1))in forced vital capacity(FVC)in the first second(FEV_(1)/FVC),and the percentage of FEV_(1) in the estimated value(FEV_(1)%pred)were measured by the pulmonary function meter.All patients were followed up for 6 months after discharge,and the prognosis information was collected(divided into poor prognosis and good prognosis).The risk factors affecting the prognosis of patients with AECOPD were screened by binary logistic univariate and multivariate regression.The area under receiver operating characteristic(ROC)/area under the curve(AUC)was used to evaluate the prognostic value of CAR combined with FAR in patients with AECOPD.Results WBC,N%,ESR,CRP,FIB,CAR,FAR,and PaCO_(2) of AECOPD patients in the poor prognosis group were higher than those in the good prognosis group,while BMI,ALB,FEV_(1)/FVC,and FEV_(1)%pred of AECOPD patients in the poor prognosis group were lower than those in the good prognosis group,with statistical significance(P<0.05).Binary logistic univariate regression analysis showed that WBC,N%,ESR,CAR,FAR,PaCO_(2),BMI,FEV_(1)/FVC,and FEV_(1)%pred were all risk factors affecting the poor prognosis of AECOPD patients.Binary logistic multivariate regression analysis showed that WBC,CAR,FAR,PaCO_(2),and FEV_(1)%pred were independent risk factors for poor prognosis in AECOPD patients.The AUC for predicting poor prognosis of AECOPD was 0.811,797,and 0.820,the sensitivity was 0.742,0.675,and 0.550,and the specificity was 0.771,0.829,and 0.950,respectively.Conclusion The combination method of CAR and FAR in predicting the prognosis of patients with AECOPD is better than single indicator,and it can be used as an important reference indicator for clinical evaluation of the prognosis of patients with AECOPD.