预后营养指数、C反应蛋白与血清白蛋白比值对克罗恩病合并腹腔感染的诊断价值  

Diagnostic value of prognostic nutritional index and C-reactive protein to albumin ratio in Crohn′s disease complicated with intra-abdominal infection

作　　者：赵琳琳 王涵菁 陈林江[2] 白杨[3] 智发朝[3] 吴京[1] Zhao Linlin;Wang Hanjing;Chen Linjiang;Bai Yang;Zhi Fachao;Wu Jing(Department of General Practice,Huiqiao Medical Center,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Ophthalmology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastroenterology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院惠侨医疗中心全科医学科,广州510515 [2]南方医科大学南方医院眼科,广州510515 [3]南方医科大学南方医院消化内科,广州510515

出　　处：《中华消化杂志》2022年第10期695-700,共6页Chinese Journal of Digestion

摘　　要：目的探讨预后营养指数(PNI)、C反应蛋白与血清白蛋白比值(CAR)对克罗恩病合并腹腔感染(CD-IAI)的诊断价值。方法回顾性分析2016年1月至2021年12月南方医科大学南方医院确诊的克罗恩病和CD-IAI患者各61例的临床资料。比较克罗恩病患者与CD-IAI患者的克罗恩病活动指数(CDAI)、克罗恩病内镜严重程度指数(CDEIS),实验室检查指标[白细胞计数、中性粒细胞比例、血小板计数、C反应蛋白(CRP)、降钙素原、D-二聚体、凝血酶原时间(PT)、纤维蛋白原、活化部分凝血活酶时间(APTT)等],以及PNI和CAR。另选择2022年1至5月南方医科大学南方医院确诊的克罗恩病患者30例和CD-IAI患者13例以验证PNI、CAR预测CD-IAI的准确性。应用受试者操作特征曲线(ROC)计算PNI、CAR及两者联合预测CD-IAI的最佳截断值、曲线下面积(AUC)、约登指数、灵敏度和特异度。运用Spearman相关分析PNI、CAR、CDAI、CDEIS的相关性,采用多因素logistic回归分析CD-IAI的影响因素。采用独立样本t检验和Mann-Whitney U检验进行统计学分析。结果CD-IAI患者CDAI、CDEIS均高于克罗恩病患者[(256.68±8.50)分比(144.87±7.83)分、3.80分(1.80分,5.40分)比1.20分(0.20分,2.80分)],差异均有统计学意义(t=-9.67、Z=-4.02,均P<0.001)。CD-IAI患者白细胞计数、中性粒细胞比例、血小板计数、CRP、降钙素原、D-二聚体、PT、纤维蛋白原、APTT均高于克罗恩病患者[7.81×10^(9)/L(5.98×10^(9)/L,11.39×10^(9)/L)比5.94×10^(9)/L(4.86×10^(9)/L,7.11×10^(9)/L)、(73.43±10.67)%比(62.30±11.03)%、360.00×10^(9)/L(266.50×10^(9)/L,456.00×10^(9)/L)比294.00×10^(9)/L(222.50×10^(9)/L,356.00×10^(9)/L)、44.27 mg/L(16.82 mg/L,82.65 mg/L)比3.42 mg/L(0.59 mg/L,18.33 mg/L)、0.07μg/L(0.04μg/L,0.22μg/L)比0.04μg/L(0.02μg/L,0.05μg/L)、0.75 mg/L(0.32 mg/L,2.00 mg/L)比0.26 mg/L(0.15 mg/L,0.46 mg/L)、11.90 s(11.40 s,12.90 s)比11.20 s(10.45 s,11.70 s)、4.58 g/L(3.59 g/L,5.59 g/L)比2.99 g/L(Objective To investigate the diagnostic value of prognostic nutritional index(PNI)and C-reactive protein to albumin ratio(CAR)in Crohn's disease complicated with intra-abdominal infection(CD-IAI).Methods From January 2016 to December 2021,the clinical data of 61 patients with Crohn's disease(CD)and 61 patients with CD-IAI diagnosed at Nanfang Hospital,Southern Medical University were retrospectively analyzed.Crohn′s disease activity index(CDAI),Crohn's disease endoscopic index of severity(CDEIS),laboratory parameters(white blood cell count,neutrophil ratio,platelet count,C-reactive protein(CRP),procalcitonin(PCT),D-dimer,prothrombin time(PT),fibrinogen,activated partial thromboplastin time(APTT)),PNI and CAR were compared between CD patients and CD-IAI patients.From January to May in 2022 another 30 patients with CD and 13 patients with CD-IAI diagnosed at Nanfang Hospital,Southern Medical University were selected to verify the accuracy of PNI and CAR in predicting CD-IAI.The optimal cut-off values of PNI and CAR in predicting CD-IAI,area under the curve(AUC),Youden index,sensitivity and specificity were calculated by receiver operating characteristic curve(ROC).Spearman correlation was used to analyze the correlation between PNI,CAR,CDAI,and CDEIS,and logistic regression was performed to analyze the influencing factors of CD-IAI.Independent sample t test and Mann-Whitney U test were used for statistical analysis.Results CDAI and CDEIS were higher in CD-IAI patients than those of CD patients(256.68±8.50 vs.144.87±7.83;3.80(1.80,5.40)vs.1.20(0.20,2.80)),and the differences were statistically significant(t=-9.67,Z=-4.02,both P<0.001).The white blood cell count,neutrophil ratio,platelet count,CRP,PCT,D-dimer,PT,fibrinogen,and APTT of CD-IAI patients were all higher than those of CD patients(7.81×10^(9)/L(5.98×10^(9)/L,11.39×10^(9)/L)vs.5.94×10^(9)/L(4.86×10^(9)/L,7.11×10^(9)/L);(73.43±10.67)%vs.(62.30±11.03)%;360.00×10^(9)/L(266.50×10^(9)/L,456.00×10^(9)/L)vs.294.00×10^(9)/L(222.50×10^(9)/L,356.00×

关 键 词：预后营养指数 C反应蛋白与血清白蛋白比值 CROHN病 腹腔内感染 

分 类 号：R574[医药卫生—消化系统] R446.5[医药卫生—内科学]