当前位置:

网站首页>文章详情

CRP/ALB比值对先天性心脏病相关肺动脉高压患者长期预后的评估价值

【PDF在线阅读】 【下载PDF】
  • 中图分类号:

摘要:

目的 探讨C反应蛋白(CRP)/白蛋白(ALB)比值对先天性心脏病相关肺动脉高压患者
长期预后的评估价值。方法 选取2014年6月至2018年5月于西安交通大学第一附属医院就诊的先天性心
脏病(CHD)合并肺动脉高压(PAH)患者216例,根据3年随访结果将患者分为生存组(174例)和死
亡组(42例)。全自动生化分析仪检测CRP、ALB并计算CRP/ALB。绘制受试者工作特征曲线(ROC)
并计算曲线下面积(AUC)分析CRP/ALB对CHD合并PAH患者预后的预测价值,多因素Logistic回归
分析探讨CHD合并PAH患者预后的相关因素。结果 死亡组血肌酐、血钾、N末端脑钠肽前体(NTproBNP)
、高敏肌钙蛋白T(hs-cTnT)、静息心率、CRP和CRP/ALB明显高于生存组,ALB显著低于
生存组(P<0.05)。CRP/ALB比值与血肌酐、NT-proBNP、hs-cTnT、NYHA心功能分级存在显著正相
关(r=0.413、0.583、0.621、0.677,P<0.05)。CRP、ALB在预测CHD合并PAH患者预后的ROC曲线
下面积(AUC)分别为0.720(95%CI:0.656~0.798)、0.662(95%CI:0.608~0.713)。在85.3 mg/L的
临界值下,CRP预测的灵敏度为74.4%,特异度为71.2%;在27.5 g/L的临界值下,ALB预测的灵敏度为
66.4%,特异度为83.2%。CRP/ALB的AUC为 0.837(95%CI:0.768~0.903),灵敏度为85.1%,特异度
为84.5%。多因素Logistic回归分析结果显示:模型1(未校正前)、模型2(校正性别、年龄、收缩压、
舒张压后、静息心率、血钾)、模型3(在模型2基础上再校正NT-proBNP、hs-cTnT、血肌酐、NYHA
心功能分级)的CRP/ALB比值的OR及95%CI分别为2.036(1.284~3.227)、1.944(1.558~2.426)、1.868
(1.594~2.189),CRP/ALB比值是CHD合并PAH患者预后不良(死亡)的独立预测因素(P<0.05)。结
论 CRP/ALB比值是CHD合并PAH患者预后死亡风险的独立预测因子,且与NYHA心功能分级有关,有望
成为CHD病情早期并发症筛查的生物标志物,CRP/ALB比值升高预示预后死亡风险高。

Abstract:

Objective To investigate the evaluation value of the ratio of C-reactive protein(CRP) to albumin(ALB) in the long-term prognosis of patients with congenital heart disease-related pulmonary hypertension. Methods A total of 216 patients with congenital heart disease (CHD) and pulmonary hypertension (PAH) who were treated in our hospital from June 2014 to May 2018 were selected, and the patients were divided into survival group (174 cases) and death group(42 cases) based on the results of the 3-year follow-up. Automatic biochemical analyzer was used to detect the level of CRP and ALB and then calculate CRP/ALB. The receiver operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was calculated to analyze the predictive value of CRP/ALB on the prognosis of patients with CHD and PAH. Multivariate logistic regression analysis explored the prognostic factors of patients with CHD and PAH. Results Serum creatinine, serum potassium, NT-proBNP, hscTnT, resting heart rate, CRP, and CRP/ALB in the death group were significantly higher than in the survival group, and ALB was significantly lower than in the survival group (P<0.05). CRP/ALB ratio was significantly positively correlated with serum creatinine, NT-proBNP, hs-cTnT, NYHA cardiac function classification (r=0.413, 0.583, 0.621, 0.677, P<0.05). The area under the ROC curve (AUC) of CRP and ALB in predicting the prognosis of patients with CHD and PAH were 0.720 (95%CI: 0.656~0.798) and 0.662 (95%CI: 0.608~0.713), respectively. Under the critical value of 85.3 mg/L, the sensitivity of CRP prediction was 74.4%, and the specificity was 71.2%. Under the critical value of 27.5 g/L, the sensitivity of ALB prediction was 66.4%, and the specificity was 83.2%. The AUC of CRP/ALB was 0.837 (95%CI: 0.768~0.903), the sensitivity was 85.1%, and the specificity was 84.5%. The results of multivariate logistic regression analysis showed that: the OR and 95% CI of the CRP/ALB ratio of Model 1 (before adjustment), Model 2 (adjusted for gender, age, systolic blood pressure, diastolic blood pressure, resting heart rate, serum potassium), Model 3 (based on model 2 and then adjusted for NT-proBNP, hs-cTnT, blood creatinine, NYHA cardiac function classification) were 2.036 (1.284~3.227), 1.944 (1.558~2.426), 1.868 (1.594~2.189), and CRP/ALB ratio was an independent predictor of poor prognosis (death) in patients with CHD and PAH(P<0.05). Conclusion The CRP/ALB ratio is an independent predictor of the prognostic death risk of patients with CHD and PAH and is related to the NYHA cardiac function classification. It is expected to become a biomarker for screening early complications of CHD. An increase in the CRP/ALB ratio predicts a high prognostic risk of death.

基金项目:

陕西省重点研发计划一般项目-社会发展领域
(2021SF-322);陕西省自然科学基金面上项目(2020JM-378)

参考文献:

  • 2008

  • 1

通讯地址:北京市东城区东四十条南门仓5号
电话: 237499284 邮编:100700
网址:www.ebcvm..org Email: ebcvm_cj@126.com

copyright © 《中国循证心血管医学杂志》编辑部
当您在使用本网站投稿遇到困难时,
请拨打400-921-9838
或直接将稿件投送到编辑部邮箱ebcvm_cj@126.com