Assessment of C-Reactive Protein/Serum Albumin Ratio in Relation to Acute Presentation and Early Outcome of Patients with Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality. C reactive protein (CRP) has linked with long-term risk of recurrent cardiovascular events or death. Albumin, in contrast to CRP known as a negative acute-phase protein. Thus a newly introduced marker assessed relation of CRP to albumin ratio (CAR), which may provide better results than the use of either marker alone. The aim of the study is to assess the association of C-reactive protein to albumin ratio (CAR) with in-hospital short-term major adverse cardiac events (MACEs) in acute coronary syndrome (ACS) patients. Patients & Methods: A multi-centers prospective cohort study was conducted at coronary intensive care units (CICU) in Baghdad during the period from March to October 2021 that included a total of 132 patients who were diagnosed as a case of ACS. They were assessed for major adverse cardiac events (MACEs) like cardiogenic shock, arrhythmias, post-MI angina, and acute heart failure while inside the ward, in addition to need for early interventional therapeutic approach in relation to (CAR) immediately at time of admission to hospital. Results: High values of CAR, whether using hs-CRP or CRP, were identified as an independent predictor for in-hospital MACEs (P value Conclusion: The CAR was independently correlated with in-hospital short-term MACEs and can be used for risk stratification in patients with ACS.

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.

C-reactive protein as a risk factor for acute coronary syndrome

Objective We assessed the levels of C reactive protein (CRP)in patients with acute coronary syndrome (ACS) [including unstable angina pectoris (UAP), acute myocardial infarction (AMI) and sudden cardiac death (SCD)] compared with non ACS [including stable angina pectoris (SAP), old myocardial infarction (OMI) and healthy volunteers] and sought to test whether CRP are associated with clinical acute coronary syndrome. Methods Ultrasensitive immunoassay (rate nephelometry with the Beckman Array multitest immunoassay system) was used to measure CRP levels in 91 patients with ACS (20 UAP, 71 AMI including 2 SCD) and non ACS (34 SAP, 25 patients with healing phase of AMI , 41 OMI and 94 control healthy subjects). Results CRP levels were higher in ACS group (18.50±23.98 mg/L [SE 2.51, n=91]) compared with non-ACS group (3.89±7.14 mg/L [SE 0.51, n=194]) (P< 0.01). Using Logistic Regression, CRP was a potent determinant of ACS(OR=1.65). Conclusion These results suggest that CRP has a strong association with ACS, and CRP is a risk factor of ACS.

The Role of C-Reactive Protein, Granulocyte Colony Stimulating Factor and Total Antioxidant Capacity in Diagnosis of Acute Appendicitis

Background and Aim: Despite the fact that acute appendicitis is the most common surgical emergency all around the world, its diagnosis is still based on clinical evaluation and accuracy of the diagnosis depending on experience. The aim of this study is to evaluate the role of inflammatory markers in diagnosis of acute appendicitis. Material and Method: The study includes 77 cases with histopathologically proven acute appendicitis and 17 control cases. Blood samples were obtained from all cases and C-reactive protein (CRP), Granulocyte Colony Stimulating Factor (G-CSF) and Total Antioxidant Capacity (TAC) were measured. Findings: In cases with acute appendicitis, CRP and G-CSF levels were found to be related to acute appendicitis;however, TAC was not affected by the disease process. Moreover, CRP and G-CSF levels were correlated with the disease severity. Conclusion: Both CRP and G-CSF can be used in diagnosis of acute appendicitis. Furthermore, increased CRP level can be a marker to show advanced cases. However, G-CSF is not an effective marker to show disease severity.

Correlation between C-reactive Protein and Morphology of Aortic Intramural Hematoma on CT Angiography

Objectives To investigate the morphologic characteristics of intramural hematoma(IMH)on CT angiography(CTA),and evaluate the possible correlation of serum C-reactive protein(CRP)with morphologic characteristics of IMH.Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study,including 30 males and 12 females,with the mean age of 61±14 years old.The volumetric CT data were retrospectively processed and analyzed on post-processing workstation.Based on the thickness of IMH and the length-area curve,the crosssectional area of true lumen and total vessel were measured,the hematoma-vessel ratio(HVR)was calculated.Imaging characteristics were compared between patients who had pathological elevated CRP(>0.8 mg/dl)and those did not.Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic validity of CRP.Results Of all 42 IMH patients,the mean serum CRP was 3.94±4.71 mg/dl,and the mean HVR was 46.7%±14.2%.HVR in patients with elevated CRP was significantly higher than those with normal CRP(49.7%±15.0%vs.40.7%±10.5%,P=0.030).HVR was mildly correlated with CRP in all patients(r=0.48,P<0.001).CRP levels differed neither between patients with Stanford type A and B(P=0.207),nor between patients with and without intimal disruption(P=0.230).To discriminate HVR>47%(the mean value),the area under curve(AUC)were 0.700(95%CI:0.535-0.865)for CRP at a cutoff point of 3.55 mg/dl,with a sensitivity of 54.5%and a specificity of 90.0%.Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH,but not with Stanford types and the presence of intimal disruption.

Myeloperoxidase and High-Sensitivity C-Reactive Protein for Predicting Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease

Background: Research has shown that high-sensitivity C-reactive protein (hs-CRP) is a major inflammatory marker for prediction of acute coronary syndrome (ACS). Myeloperoxidase (MPO) also plays an important role in atherosclerosis initiation and development. In present study, the major adverse cardiovascular events (MACEs) of patients with coronary heart disease (CHD) were investigated. Methods: MPO, hs-CRP and ACS-related risk factors from 201 ACS (78 AMI and 123 UAP) and 210 non-ACS (84 SAP and 126 non-CHD) patients confirmed by coronary angiography were detected, and the data were analyzed with receiver operating characteristic (ROC) curve and Spearman’s correlation coefficients. MACEs of 285 CHD patients were investigated during the 4-year period follow-up from March 2010 to May 2014. Results: The areas under ROC curve for diagnosing ACS were 0.888 (95% CI 0.843 - 0.933) for MPO, and 0.862 (95% CI 0.815-0.910) for hs-CRP, respectively. There were significantly correlations between MPO and hs-CRP in both ACS and non-ACS groups. Regarding to ACS patients, both MPO and hs-CRP were positively correlated with BMI, TC, TG, LDL-C and Hcy. Prospective study demonstrated that the incidences of MACEs associated significantly with elevated MPO baseline level (yes vs no, OR 7.383, 95% CI 4.095 - 13.309) and high hs-CRP baseline level (yes vs no, OR 4.186, 95% CI 2.469 - 7.097) in CHD patients. Conclusions: The present study provides the epidemiological evidence that elevated baseline MPO and hs-CRP levels are both valuable predictors of MACEs in CHD patients. MPO and hs-CRP would prompt the progression of atherosclerosis and development from SAP to ACS.

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

INTRODUCTIONThe spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis

AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission.METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated.RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAP vs Acute Physiology and Chronic Health Evaluation II within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27 vs 4.61, respectively.CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis.

Daclizumab prevents acute renal allograft rejection: 1 year analysis

Objective：To investigate the clinical effect of Daclizumab on preventing acute rejection in renal transplant recipients. Methods：71 patients were randomly divided into two groups：Daclizumab group （n =26） and control group （n = 45）. Baseline regimen of mycophenolate mofetil （MMF）, cyclosporin （CsA）, methylprednisolone （MPD） and prednisone （Pred） were administered to all patients. The treatment of Daclizumab was based on baseline regimen. The Daclizumab group received Daclizumab twice before and after renal transplant. The occurrence of post-transplantation acute rejection, renal function and T lymphocyte subtypes were sequentially monitored; meanwhile adverse events, infection episode, and patient and graft survival were observed. All of patients received a follow-up of 12 months at least. Results：The occurrence of acute rejection in Daclizumab group in 1, 3, 6 and 12 months after renal transplantation was 7.7%, 19.2%, 23.1% and 30.8%, respectively,while it was 15.6% ,28.9%, 35.6% and 46.7% in the control group. There was significant difference between the two group（P 〈 0.05）. There was no difference in infection episodes and adverse events between the Daclizumab group and control group. One year patient survival was 92.3% in Daclizumab group, 91.1% in control group （P 〉 0.05）, compared with graft survival of 96.2 % and 93.3 % for Daclizumab and control group, respectively （P 〉 0. 05）. The renal function in Daclizumab group in 1, 6 and 12 months after renal transplantation was better than that in control group （P 〈 0,05）. The CD3＋ and CD4＋ subtypes decreased in both two groups after operation but no significant difference （P 〉 0.05）. Conclusion：Daclizumab combined with MMF,CsA,MPD and Pred therapeutic regimen was effective to reduce the occurrence of acute rejection in renal transplant recipients and have no influence on T lymphocyte subtypes.

Effects of Suhuang Zhike Capsule on Pulmonary Function, Blood Gas Analysis Index, Serum PCT and CRP Expression in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

OBJECTIVE: To observe the effects of Suhuang Zhike Capsule on pulmonary function, blood gas analysis index, serum PCT and CRP expression in patients with acute exacerbation of chronic obstructive pulmonary disease. METHODS: A total of 88 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the Department of Respiratory Medicine, Xuancheng People's Hospital of Anhui Province from December 2014 to December 2016 were randomly divided into the observation group and the control group, with 44 cases in each group. The control group was given routine clinical treatment, and the observation group was given Suhuang Zhike Capsule on the basis of the treatment method of the control group. After 7 days' treatment, the improvement of lung function indexes were observed and evaluated before and after treatment(forced expiratory volume in one second(FEV_1), forced expiratory volume occupancy in the 1^(st) second percentage of vital capacity(FEVl/FVC), peak expiatory flow(PEF)), blood gas analysis index(Arterial oxygen partial pressure(PaO_2) and arterial blood carbon dioxide partial pressure(PaCO_2), oxygenation index(OI)) and serum cytokine levels(procalcitonin(PCT) and C reactive protein(CRP). RESULTS: The total effective rate of the observation group was significantly higher than that of the control group(P < 0.05). The FEV_1, FEV_1/FVC and PEF in 2 groups were significantly increased after the treatment(P < 0.05), and the above lung function indexes in the observation group were significantly higher than the control group(P < 0.05). PaO_2 and OI were significantly increased after the treatment(P < 0.05), PaCO_2 was significantly decreased after the treatment(P < 0.05), and the improvement of above blood gas analysis indexes were significantly superior of the observation group than the control group(P < 0.05). The serum PCT and CRP levels in 2 groups were significantly decreased after the treatment(P < 0.05), and the improvement in the observation group were more significant than that in the control group(P < 0.05). CONCLUSION: Suhuang Zhike Capsule can inhibit serum inflammatory cytokine levels in patients with acute exacerbation of chronic obstructive pulmonary disease, improve blood gas analysis indicators, and improve lung functions.

Differences in Acute Phase Reactants between Gout and Pseudogout

Objectives: To define clinical differences in the acute phase response and serum acute phase reactants between gout, pseudogout and crystal-induced arthritis in the presence of non-articular infections (CAI). Patients and Methods: Eleven patients with definite gout, 12 patients with pseudogout and 5 patients with CIA were included in the study. Results: The erythrocyte sedimentation rate (ESR) was significantly different between gout (68.2 ± 49.9 mm/Hr) and CIA (113.8 ± 37.2 mm/Hr) but not between gout and pseudogout (83.9 ± 45.6 mm/Hr) or between pseudogout and CIA. The C-reactive protein (CRP) was significantly increased between gout (10.1 ± 7.9 mg/dL) and pseudogout (18.9 ± 9.8 mg/dL), gout and CIA (36.5 ± 12.4 mg/dL) as well as between pseudogout and CIA. The peripheral white cell count was significantly different between gout (9.27 ± 3.7 k/μL) and CIA (16.5 ± 6.8 k/μL), and between pseudogout (8.9 ± 3.2 k/μL) and CIA. Conclusions: Measurement of ESR and CRP are helpful in crystal-induced arthritis. The CRP has more discriminating utility than the ESR in distinguishing between gout, pseudogout and CIA. Peripheral wbc is most useful for differentiating crystal-induced arthritis from CIA.

Lp-PLA2、hs-CRP和FIB联合检测在急性脑梗死诊断中的应用

目的探讨血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)和纤维蛋白原(FIB)联合检测在急性脑梗死诊断中的临床价值。方法收集我院240例急性脑梗死的住院患者作为研究对象(脑梗组),以100例门诊体检健康人员为对照组,比较两组人群的一般临床数据及检验结果,记录患者入院时的NIHSS评分。分析急性脑梗死患者血浆Lp-PLA2、hs-CRP和FIB水平与其神经功能缺损程度的关系,进行多因素Logistic回归分析确定急性脑梗死的危险因素,利用ROC曲线评估患者血浆Lp-PLA2、hs-CRP和FIB水平对急性脑梗死的诊断价值。结果重度脑梗死患者的Lp-PLA2、hs-CRP和FIB水平均高于轻度及中度脑梗死患者(P<0.05);与对照组比较,脑梗组患者的血浆Lp-PLA2、hs-CRP和FIB水平均显著升高,差异均具有统计学意义(P<0.05)。血浆Lp-PLA2、hs-CRP和FIB水平与急性脑梗死发病风险显著相关(P<0.05)。Lp-PLA2、hs-CRP和FIB 3个指标中,Lp-PLA2的ROC曲线下面积最大,诊断价值最高;Lp-PLA2、hs-CRP和FIB联合检测能显著提高急性脑梗死的诊断效率。结论联合检测Lp-PLA2、hs-CRP和FIB对判断ACI患者神经功能缺损程度具有较高价值。

降钙素原与白蛋白比值对腹腔感染引起的脓毒症相关急性肾损伤不良预后的评估价值

目的探讨腹腔感染引起的脓毒症相关急性肾损伤(AKI)的危险因素,并分析其在脓毒症相关AKI病人不良预后中的诊断价值。方法前瞻性分析南京医科大学附属淮安第一医院重症监护室(ICU)2019年1月至2022年12月231例由腹腔感染引起的脓毒症相关AKI病人的临床资料,根据病人随访预后情况将其分为生存组(137例)和死亡组(94例)。采用单因素分析法比较两组病人的临床资料;多因素logistic回归分析脓毒症相关AKI病人不良预后的独立危险因素;受试者操作特征曲线(ROC曲线)评价血清降钙素原(PCT)、C反应蛋白(CRP)、PCT/白蛋白(Alb)、CRP/Alb对脓毒症相关AKI病人不良预后的诊断价值。结果单因素分析显示,231例脓毒症相关急性肾损伤,小肠坏死或穿孔疾病引起的病死率明显高于回盲阑尾疾病的病死率(31.9%比11.7%)(P<0.001);死亡组PCT浓度显著高于生存组[28.65(18.73,78.97)mg/L比8.0(1.05,21.73)mg/L](P<0.001);同样,死亡组CRP浓度显著高于生存组[224.37(180.10,263.15)mg/L比186.3(136.33,235.84)mg/L](P<0.001);死亡组PCT/Alb和CRP/Alb比值均显著高于生存组[2.29(0.73,3.78)比0.25(0.04,0.53)和10.78(6.91,13.79)比5.75(5.30,10.92)](均P<0.001);多因素logistic回归分析显示,PCT/Alb、CRP/Alb是脓毒症诱导AKI病人不良预后的独立危险因素。进一步的ROC曲线显示,PCT/Alb预测脓毒症AKI病人不良预后的准确性均高于CRP/Alb,曲线下面积(0.86比0.74)、特异度(84.7%比61.3%)、灵敏度(78.7%比75.5%)。结论PCT/Alb不仅是评估腹腔感染引起的脓毒症相关急性肾损伤病人不良预后的独立危险因素,更能为临床改善此类疾病管理和降低病死率方面提供一定帮助。

急性颅脑损伤患者CT评分变化及血清乳酸、NSE、CRP的相关性分析

目的探讨急性颅脑损伤(ACI)患者计算机断层扫描(CT)评分变化与血清乳酸(LA)、神经元特异性烯醇化酶(NSE)及C-反应蛋白(CRP)水平的关系及其对预后的预测价值。方法选取2020年1月—2022年1月东台市人民医院收治的50例急性颅脑损伤患者作为疾病组,根据患者治疗后格拉斯哥预后评分(GOS)分为预后良好组(32例)和预后不良组(18例);选取50例行健康体检受试者作为健康组。受试者工作特征曲线(ROC)评估血清乳酸、NSE、CRP水平与CT评分对急性颅脑损伤患者预后的评估价值。结果疾病组血清乳酸、NSE、CRP水平均高于健康组(P<0.05);预后不良组乳酸、NSE、CRP水平和CT评分均高于预后良好组;经Spearman相关分析,急性颅内损伤患者血清中乳酸、NSE、CRP水平与CT评分呈正相关(r=0.431、r=0.345、r=0.226,均P<0.05);ROC曲线分析显示,血清乳酸、NSE、CRP水平、CT评分联合预测急性颅内感染预后的曲线下面积(AUC)高于单一指标检测(P<0.05)。结论急性颅脑损伤患者CT评分与患者入院血清乳酸、NSE、CRP水平呈正相关,联合诊断对患者预后评估有一定价值。

下调PDCD4抑制MAP2K3和p38 MAPK的表达减轻LPS诱导的肾小管上皮细胞炎症和凋亡

目的研究程序性细胞死亡蛋白4(programmed cell death protein 4,PDCD4)在脓毒症诱导的急性肾损伤(acute kidney injury,AKI)中的作用机制,以及调控PDCD4表达通过丝裂原活化蛋白激酶3(mitogen-activated protein kinase 3,MAP2K3)和p38蛋白激酶(p38 mitogen-activated protein kinase,p38 MAPK)对脓毒症AKI起到潜在治疗作用。方法用脂多糖(lipopolysaccharide,LPS)刺激人肾小管上皮细胞(HK-2)构建脓毒症AKI细胞模型。进一步用腺病毒介导siRNA和过表达载体抑制和上调AKI细胞模型中PDCD4的表达;CCK-8法检测细胞增殖;用DCFH-DA及激光共聚焦显微镜检测细胞中ROS水平,用总SOD活性检测试剂和MDA检测试剂盒检测细胞中SOD和MDA水平;免疫共沉淀验证PDCD4和MAP2K3之间的蛋白相互作用;TUNEL染色法检测细胞凋亡;RT-qPCR和Western blot检测PDCD4及相关基因的mRNA和蛋白表达水平;ELISA法检测患者血清中炎症相关因子水平。结果LPS诱导可以促进HK-2细胞中PDCD4表达,下调PDCD4可抑制LPS诱导的HK-2细胞的炎症、氧化应激及细胞凋亡。数据库预测及免疫共沉淀证实PDCD4可以与MAP2K3相互作用,且在LPS诱导的HK-2细胞中,MAP2K3表达水平显著增强。MAP2K3过表达和p38 MAPK激动剂可以减轻PDCD4下调对LPS诱导的细胞炎症和氧化应激的影响并抑制细胞凋亡。结论下调PDCD4可以通过抑制MAP2K3和p38 MAPK从而抑制LPS诱导的肾小管上皮细胞的炎症和凋亡。

血清铁蛋白作为急性时相反应蛋白在布鲁菌病中的应用

目的:比较急、慢性布鲁菌病(简称布病)患者治疗前和治疗中外周血铁蛋白水平,评估血清铁蛋白与急、慢性布病炎性反应和布病治疗转归的关系。方法:选取急、慢性期且未接受抗生素治疗的布病患者各36例作为治疗前组;抗生素治疗10 d左右的急、慢性期布病患者各36例作为治疗中组;选取健康体检者25例作为对照组。采用酶联免疫吸附试验测定各组样本的血清铁蛋白水平,统计分析血清铁蛋白水平在各组间的差异。结果:治疗前急、慢性期和对照组血清铁蛋白水平具有明显差异(P<0.01);急、慢性组铁蛋白水平均比对照组明显增高(P<0.01);急性铁蛋白水平比慢性组明显升高(P<0.01)。治疗中急、慢性期和对照组血清铁蛋白水平具有明显差异(P<0.01);急、慢性布病组铁蛋白水平均比对照组明显增高(P<0.01);急性布病铁蛋白水平比慢性布病明显降低(P<0.01)。治疗中急性期、慢性期布病铁蛋白水平均比治疗前明显降低(P<0.001)。结论:血清铁蛋白与布鲁菌病的炎症反应程度有关,可用于监测布鲁氏菌病的炎症反应程度和评估治疗效果。

磁共振弥散加权成像联合CRP对急性缺血性脑梗死时间窗的鉴别价值

目的磁共振弥散加权成像(DWI)联合血清C反应蛋白(CRP)对急性缺血性脑梗死时间窗的鉴别价值。方法回顾性分析2021年6月至2023年6月宝鸡市中心医院收治的195例急性缺血性脑梗死患者床资料,其中男111例,女84例,年龄范围57~75岁。按发病至接受磁共振检查前时间分为超急性期组(病程≤6 h)67例、急性期组(病程6~72 h)79例、亚急性期组(≥72~168 h)49例;比较3组患者的DWI检查结果[表观弥散系数(ADC)]及CRP水平,受试者操作特征曲线(ROC)分析DWI联合CRP对急性缺血性脑梗死时间窗的鉴别价值,采用t检验、F检验进行统计分析。结果超急性期组患侧ADC为(0.33±0.08)×10^(-3) mm^(2)/s,低于急性期组的(0.40±0.09)×10^(-3) mm^(2)/s、亚急性期组的(1.56±0.25)×10^(-3) mm^(2)/s,3组比较差异有统计学意义(F=34.455,P<0.05);且超急性期组、急性期组患者患侧ADC值低于健侧,但亚急性期组患者ADC值高于健侧,差异有统计学意义(均P<0.05)。超急性期组CRP为(9.39±3.03)mg/L,高于急性期组(6.01±1.27)mg/L、亚急性期(5.48±1.33)mg/L(q=16.09、712.295,均P<0.05);但急性期组、亚急性期CRP比较差异无统计学意义(q=1.933、P>0.05)。ROC显示ADC鉴别急性缺血性脑梗死超急性期的曲线下面积(AUC)为0.587,灵敏度为100.00%、特异度为38.38%;CRP鉴别急性缺血性脑梗死超急性期的AUC为0.888,灵敏度为73.13%、特异度为96.87%;ADC联合CRP的AUC为0.918,灵敏度、特异度分别为85.07%、86.72%。结论急性缺血性脑梗死患者的ADC与血清CRP水平均可有效鉴别时间窗,ADC鉴别超急性缺血性脑梗死存在高灵敏度优势,CRP则具有高特异度优势,两者联合可进一步优化鉴别效能。

C反应蛋白、降钙素原和白细胞介素6在早期急性胰腺炎合并感染中的诊断价值分析

目的探讨C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)在早期急性胰腺炎(AP)合并感染中的诊断价值。方法选择2022年1月至2024年1月滕州市中心人民医院消化内科收治的112例AP患者,依据患者入院时的严重程度将其划分为3组分别为轻症组、中重症组、重症组。记录入院首日、3 d、7 d,IL-6、CRP、PCT水平;同时以Spearman相关性分析病情严重程度与IL-6、CRP、PCT相关性。结果入院首日,3组患者IL-6、CRP、PCT水平均高于各指标正常参考范围。IL-6水平入院首日、入院3 d、入院7 d,重症组>中重症组>轻症组(P<0.05),且入院7 d>入院3 d>入院首日(P<0.05)。CRP水平,重症组、中重症组入院首日无差异(P>0.05),重症组、中重症组>轻症组(P<0.05);入院3 d、入院7 d,重症组>中重症组>轻症组(P<0.05),且入院7 d>入院3 d>入院首日(P<0.05)。入院不同时间三组PCT水平,均重症组>中重症组>轻症组(P<0.05);轻症组、中重症组入院不同时间段PCT水平,均入院3 d>入院7 d>入院首日(P<0.05);重症组入院3 d、入院7 d比较无差异(P>0.05),入院3 d、入院7 d>入院首日(P<0.05)。IL-6、CRP、PCT、IL-6+CRP+PCT对AP的AUC分别为0.82、0.85、0.90、0.94。IL-6、CRP、PCT预测AP的截断值分别为50.77 ng/L、124.56 mg/L、3.25μg/L。经ROC曲线分析显示,PCT为最佳AP预测因子,IL-6、CRP、PCT联合诊断准确性更高。结论PCT、CRP、IL-6单一或联合用于AP合并感染的诊断评估均具有一定价值,且三者联合应用诊断价值更高,可早期评价患者病情严重程度,指导疾病治疗,建议将其作为AP早期病情评估、预后预测参考指标。

重症急性胰腺炎并发持续炎症-免疫抑制-分解代谢综合征的列线图预测模型构建与验证

目的在重症急性胰腺炎(severe acute pancreatitis,SAP)是否并发持续炎症-免疫抑制-分解代谢综合征(PICS)中探讨中性粒细胞与淋巴细胞计数比值(NLR)联合纤维蛋白降解产物(FDP)与D-二聚体比值等指标的临床预测效能,并构建预测模型。方法回顾性收集2018年5月至2023年5月安徽医科大学第一附属医院重症医学科、急诊医学科、消化内科入住的133例SAP患者的临床资料。根据PICS诊断标准将其分为SAP并发PICS组(60例)和SAP非并发PICS组(73例),对两组间NLR、FDP与D-二聚体比值及常见临床指标进行回顾性分析;比较两组患者临床特征、重症监护病房(ICU)病死率及随访1年后生存率。采用Lasso回归及多因素Logistic回归筛选出独立危险因素,构建列线图预测模型。采用受试者工作特征(ROC)曲线、校准曲线对模型进行内部验证;采用临床决策曲线分析(DCA)评估模型的临床实用性。结果与SAP非并发PICS组比较,SAP并发PICS组的改良Marshall评分、NLR、血小板计数与淋巴细胞计数比值(PLR)及FDP与D-二聚体比值均明显升高(P<0.05);SAP并发PICS组合并血流感染及腹腔感染比例明显高于SAP非并发PICS组(P<0.05);通过多因素Logistic回归分析发现,NLR、FDP与D-二聚体比值是SAP并发PICS的独立危险因素(OR分别为0.790、0.131,P均<0.05)。Lasso回归筛选的预测变量得到三因素逻辑回归模型,预测变量包括FDP/D-二聚体、NLR、C反应蛋白(CRP)/前白蛋白(OR分别为1.981、1.048、4.726,P均<0.05)。将上述因素进行模型拟合,经bootstrap内部验证列线图模型曲线下面积(AUC)为0.948(95%CI 0.909~0.980)。校准曲线接近参考曲线,且DCA显示预测模型具有良好临床实用性。结论基于NLR、FDP与D-二聚体比值、CRP/前白蛋白构建SAP患者并发PICS风险列线图预测模型具备良好区分度、校准度和实用性。在SAP早期对是否并发PICS进行评估,若并发PICS,可能提示患者预后不良。