联合检测C反应蛋白/纤维蛋白原、总胆红素、红细胞分布宽度预测慢性阻塞性肺疾病急性加重患者治疗应答的效能

Efficacy of Combined Detection of CRP/FIB,Total Bilirubin,and RDW in Predicting the Therapeutic Response in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的分析联合检测C反应蛋白(CRP)与纤维蛋白原(FIB)比值、总胆红素、红细胞分布宽度(RDW)预测慢性阻塞性肺疾病急性加重(AECOPD)患者治疗应答的效能。方法选取2020年1月至2023年2月收治的265例AECOPD患者,根据疗效分为有效组241例和无效组24例,比较2组治疗前、治疗3 d后、治疗5 d后CRP/FIB、总胆红素、RDW水平,分析治疗5 d后CRP/FIB、总胆红素、RDW水平对疗效的影响,受试者工作特征曲线分析治疗3、5 d后CRP/FIB、总胆红素、RDW及联合对AECOPD疗效预测效能。结果有效组治疗3、5 d后CRP/FIB、RDW低于无效组,总胆红素高于无效组(P<0.05)。危险度分析显示,治疗5 d后CRP/FIB、RDW高表达亚组无效的风险分别是低表达亚组的1.081、1.099倍(P<0.05);总胆红素高表达亚组无效的风险是低表达亚组的0.922倍(P<0.05);绘制受试者工作特征曲线显示,治疗3 d后CRP/FIB、总胆红素联合RDW的曲线下面积大于各指标单独的曲线下面积(P<0.01);治疗5 d后CRP/FIB、总胆红素联合RDW的曲线下面积大于各指标单独的曲线下面积(P<0.01);治疗5 d后CRP/FIB、总胆红素联合RDW的曲线下面积最大,为0.932,其预测敏感度为95.83%,特异度为84.23%。结论CRP/FIB、RDW、总胆红素的变化与AECOPD治疗应答有关,均可作为预测治疗应答的标志物,联合检测三者能进一步提高预测能力,为疗效的早期预测、治疗、病情分层等提供参考。

Objective To analyze the efficacy of combined detection of the ratio of C reactive protein(CRP)to fibrinogen(FIB)(CRP/FIB ratio),total bilirubin(TBIL),and red blood cell distribution width(RDW)in predicting the therapeutic response in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 265 patients with AECOPD admitted from January 2020 to February 2023 were selected and divided into an effective group(n=241)and an ineffective group(n=24)according to the efficacy.The CRP/FIB ratio,and the levels of TBIL and RDW were compared between the two groups before treatment,and at 3 d and 5 d after treatment.The impact of CRP/FIB ratio,TBIL,and RDW levels on the efficacy at 5 d after treatment was analyzed.The receiver operating characteristic(ROC)curve analysis was used to analyze the predictive efficacy of CRP/FIB ratio,TBIL,and RDW alone and in combination on the efficacy of AECOPD at 3 d and 5 d after treatment.Results At 3 and 5 d after treatment,the CRP/FIB ratio and RDW levels in the effective group were lower than those in the ineffective group,while the TBIL level was higher than that in the ineffective group(P<0.05).Risk analysis showed that at 5 d after treatment,the risk of ineffective treatment in the high-expression CRP/FIB and RDW subgroup was 1.081 and 1.099 times higher than that in the low-expression subgroup,respectively(P<0.05);the risk of ineffective treatment in the high-expression TBIL subgroup was 0.922 times that in the low-expression subgroup(P<0.05).The ROC curve showed that the area under the ROC curve(AUC)of CRP/FIB,TBIL combined with RDW at 3 d after treatment was greater than that of each indicator alone(P<0.01).At 5 d after treatment,the AUC of CRP/FIB,TBIL combined with RDW was greater than that of each indicator alone(P<0.01).The AUC of CRP/FIB,TBIL,and RDW in combination was the largest at 5 d after treatment,with a value of 0.932,and its predictive sensitivity was 95.83%and specificity was 84.23%.Conclusion Changes in CRP/FIB,RDW and TBIL are associated with the therapeutic response of AECOPD,and can be used as markers of therapeutic response.Combined detection of the three can further improve predictive ability and provide reference for early prediction,treatment,and disease stratification of therapeutic efficacy.