血清CRP/ALB值与PCT/ALB值联合对慢性肾脏病患者病情及预后评估的价值-现代医学

血清CRP/ALB值与PCT/ALB值联合对慢性肾脏病患者病情及预后评估的价值

单位：1. 邯郸二八五医院肾内科, 河北邯郸 056001;
2. 邯郸二八五医院骨科, 河北邯郸 056001;
3. 河北省儿童医院呼吸二科, 河北石家庄 056003

分类号：R692;R446.112

出版年·卷·期（页码）：2023·51·第五期（688-692）

摘要：

目的：分析血清C反应蛋白/白蛋白(CRP/ALB)值与降钙素原(PCT)/ALB值联合对慢性肾脏病患者病情及预后评估的价值。方法：回顾性选取2019年2月至2021年5月在邯郸二八五医院诊治的慢性肾脏病患者154例为研究组，同期体检的健康受检者32例为对照组。检测所有研究对象血清CRP、ALB、PCT水平，计算CRP/ALB值和PCT/ALB值。采用Pearson相关性检验分析CRP、ALB、PCT水平与慢性肾脏病患者病情的关系；多因素Logistic回归分析慢性肾脏病预后的影响因素；受试者工作特征(ROC)曲线分析血清CRP/ALB值和PCT/ALB值联合对预后的预测价值。结果：与对照组相比，研究组血清CRP、PCT水平及CRP/ALB值、PCT/ALB值明显较高，ALB水平明显较低(P＜0.01)。研究组患者随着病情的加重，CRP、PCT水平及CRP/ALB值、PCT/ALB值逐渐升高，ALB水平逐渐降低(P＜0.05)。CRP、PCT水平及CRP/ALB值、PCT/ALB值与肾小球滤过率呈明显负相关，ALB水平与肾小球滤过率呈明显正相关(P＜0.05)。多因素Logistic回归分析显示，CRP、PCT水平及CRP/ALB值、PCT/ALB值为慢性肾脏病患者预后不良的独立危险因素(P＜0.05)，ALB水平为独立保护因素(P＜0.05)。CRP/ALB值与PCT/ALB值联合预测慢性肾脏病患者预后的ROC曲线下面积(AUC)为0.889。结论：血清CRP/ALB值和PCT/ALB值变化对判断慢性肾脏病病情及评估预后有重要的参考价值。

Objective: To analyze the value of combined serum C-reactive protein/albumin(CRP/ALB) and procalcitonin(PCT)/ALB assays in the assessment of disease and prognosis in patients with chronic kidney disease(CKD). Methods: 154 patients with CKD diagnosed and treated at the Handan 285 Hospital from February 2019 to May 2021 were retrospectively selected as study group, and 32 healthy subjects who underwent physical examination during the same period were selected as control group. The serum levels of CRP, ALB and PCT were determined and the ratios of CRP/ALB and PCT/ALB were calculated. The Pearson correlation test was used to analyze the relationship between CRP, ALB, PCT and the condition of patients with CKD and the multi-factor logistic regression analysis was used to analyze the factors influencing the prognosis of CKD. The prognostic value of the combined serum CRP/ALB and PCT/ALB tests was analyzed by the receiver operating characteristic(ROC) curve. Results: Compared with the control group, serum CRP, PCT levels and CRP/ALB, PCT/ALB were significantly higher and ALB levels were significantly lower in the study group(P＜0.01). CRP, PCT, CRP/ALB and PCT/ALB levels gradually increased and ALB levels gradually decreased with the aggravation of the disease(P＜0.05). CRP, PCT, CRP/ALB and PCT/ALB were significantly and negatively correlated with glomerular filtration rate, and ALB was significantly and positively correlated with glomerular filtration rate(P＜0.05). Multifactorial logistic regression analysis showed that CRP, PCT, CRP/ALB, and PCT/ALB were independent risk factors for poor prognosis in patients with CKD(P＜0.05), and ALB was an independent protective factor(P＜0.05). The area under the curve(AUC) of the combination of CRP/ALB and PCT/ALB for predicting prognosis in patients with CKD was 0.889. Conclusion: Changes in serum CRP/ALB and PCT/ALB are of great reference value for understanding the degree of disease and prognosis assessment of patients CKD.

参考文献：

[1] WANG Y N,MA S X,CHEN Y Y,et al.Chronic kidney disease:biomarker diagnosis to therapeutic targets[J].Clin Chim Acta,2019,499(1):54-63.
[2] RUIZ-ORTEGA M,RAYEGO-MATEOS S,LAMAS S,et al.Targeting the progression of chronic kidney disease[J].Nat Rev Nephrol,2020,16(5):269-288.
[3] ZABETIAN A,COCA S G.Plasma and urine biomarkers in chronic kidney disease:closer to clinical application[J].Curr Opin Nephrol Hypertens,2021,30(6):531-537.
[4] FAN Z,FAN K,GONG Y,et al.The CRP/Albumin ratio predicts survival and monitors chemotherapeutic effectiveness in patients with advanced pancreatic cancer[J].Cancer Manag Res,2019,11(1):8781-8788.
[5] 王芳,侯晨涛,杨晶,等.PCT/ALB比值在脓毒症诊断与预后中的临床价值[J].山西医科大学学报,2021,52(2):1626-1631.
[6] SHIN C C,CHEN S H,CHEN G D,et al.Development of a longitudinal diagnosis and prognosis in patients with chronic kidney disease:intelligent clinical decision-making scheme[J].Int J Environ Res Public Health,2021,18(23):12807.
[7] ZSOM L,ZSOM M,SALIM S A,et al.Estimated glomerular filtration rate in chronic kidney disease:a critical review of estimate-based predictions of individual outcomes in kidney disease[J].Toxins(Basel),2022,14(2):127.
[8] LIU C,FANG C,XIE L.Diagnostic utility of procalcitonin as a biomarker for late-onset neonatal sepsis[J].Transl Pediatr,2020,9(3):237-242.
[9] CHEN T K,KNICELY D H,GRAMS M E.Chronic kidney disease diagnosis and management:a review[J].JAMA,2019,322(13):1294-1304.
[10] ZHANG W R,PARIKH C R.Biomarkers of acute and chronic kidney disease[J].Annu Rev Physiol,2019,81(1):309-333.
[11] RIDKER P M,MACFADYEN J G,GLYNN R J,et al.Inhibition of interleukin-1β by canakinumab and cardiovascular outcomes in patients with chronic kidney disease[J].J Am Coll Cardiol,2018,71(21):2405-2414.
[12] RODRIGUE Z,REYES L F,MONCLOU J,et al.Relationship between acute kidney injury and serum procalcitonin(PCT) concentration in critically ill patients with influenza infection[J].Med Intensiva(Engl Ed),2018(7):399-408.
[13] 马琴琴,陈琛,周莹,等.慢性肾衰脓毒症患者NLR、CD64及CRP/Alb比值对细菌感染的早期诊断价值[J].中国病原生物学杂志,2022,17(7):840-843.
[14] 赵磊,薛剑,王瑜玲,等.脑梗死合并肺部感染病人Th1/Th2、CRP/ALB比值和NLR变化及临床意义[J].中西医结合心脑血管病杂志,2021,19(8):1388-1391.
[15] 孟子琦,梁桂菊,朱洁晨,等.PCT/Alb对老年社区获得性肺炎患者病情严重程度及预后的预测价值[J].医学研究杂志,2022,51(10):151-155.
[16] 洪国耀,汪步春,罗靖.C反应蛋白/白蛋白、降钙素原/白蛋白与急性创伤后应激障碍发病的相关性研究[J].华南国防医学杂志,2022,36(5):355-358，382.
[17] SIMSEK B,CINAR T,INAN D,et al.C-reactive protein/albumin ratio predicts acute kidney injury in patients with moderate to severe chronic kidney disease and non-st-segment elevation myocardial infarction[J].Angiology,2022(2):132-138.
[18] 王娜,秦卓,刘慧珍,等.营养风险评分对脓毒症相关性急性肾损伤患者预后的临床价值[J].中华危重病急救医学,2022,34(3):245-249.

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