超敏C反应蛋白与前清蛋白比值、Tei指数评估急性失代偿心力衰竭病人容量负荷的价值  

The Value of Ratio of Hypersensitive C-reactive Protein to Prealbumin and Tei Index in Evaluating Volume Load in Patients with Acute Decompensated Heart Failure

作　　者：杨赓[1] YANG Geng(Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院,北京100029

出　　处：《中西医结合心脑血管病杂志》2025年第6期822-829,共8页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的:探讨超敏C反应蛋白与前清蛋白比值(hs-CRP/PAB)、Tei指数对急性失代偿心力衰竭(ADHF)病人容量负荷的评估价值。方法:选取2018年11月—2023年2月我院收治的ADHF病人192例,根据病人容量负荷状态分为容量负荷正常组(68例)和容量超负荷组(124例)。比较两组一般资料、临床指标及心功能指标差异;采用多因素Logistic回归分析筛选影响ADHF病人容量超负荷的因素并建立Logistic回归模型,分析hs-CRP/PAB、Tei指数与ADHF病人容量负荷的关联强度,再建立神经网络模型并对影响因素按照重要性排序。采用受试者工作特征(ROC)曲线评估两种模型的预测效能。采用Logistic回归分析评价hs-CRP/PAB与Tei指数在评估ADHF病人容量负荷中的交互作用。结果:容量超负荷组年龄、Tei指数、超敏C反应蛋白(hs-CRP)、hs-CRP/PAB、尿素氮(BUN)、肌酐(Scr)及N末端B型利尿钠肽原(NT-proBNP)水平高于容量负荷正常组,PAB水平低于容量负荷正常组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、Scr、hs-CRP/PAB、Tei指数及NT-proBNP为ADHF病人容量超负荷的危险因素(P<0.05);hs-CRP/PAB、Tei指数与容量负荷的关联强度呈非线性剂量反应关系(P<0.01)。建立Logistic回归模型和神经网络模型预测ADHF病人容量超负荷的概率,Logistic回归模型和神经网络模型ROC曲线下面积(AUC)分别为0.934和0.955。Logistic回归模型敏感度和特异度分别为86.5%和91.1%时,约登指数为0.776,准确性为88.8%;神经网络模型敏感度和特异度分别为86.7%和91.6%时,约登指数为0.783,准确性为89.1%。神经网络模型的AUC、约登指数和准确性均较高。调整混杂因素后,hs-CRP/PAB与Tei指数存在交互作用,hs-CRP/PAB≥5.62×10^(-2)和Tei指数≥0.52存在交互作用,两因素共同存在时ADHF病人容量超负荷的风险较高[OR=6.113,95%CI(2.448,10.669)]。结论:年龄、Scr、hs-CRP/PAB、Tei指数及NT-proBNP为ADHF病�Objective:To investigate the value of ratio of hypersensitive C-reactive protein to prealbumin(hs-CRP/PAB)and Tei index in evaluating volume load in patients with acute decompensated heart failure(ADHF).Methods:A total of 192 ADHF patients were selected and divided into normal volume load group(68 cases)and volume overload group(124 cases)according to patient capacity load status.The differences of general data,clinical indexes,and cardiac function indexes were compared between the two groups.Multivariate Logistic regression analysis was used to screen factors affecting volume overload in ADHF patients,and a Logistic regression model was established to analyze the correlation strength between hs-CRP/PAB,Tei index and volume overload in ADHF patients.The neural network model was established and the influencing factors were ranked according to importance.Receiver operating characteristic(ROC)curves were used to evaluate the predictive efficacy of the two models.Logistic regression analysis was used to evaluate the interaction between hs-CRP/PAB and Tei index in evaluating volume load in ADHF patients.Results:The levels of age,Tei index,hypersensitive C-reactive protein(hs-CRP),hs-CRP/PAB,urea nitrogen(BUN),creatinine(Scr),and N-terminal B-type diuretic natriuretic peptide(NT-proBNP)in the volume overload group were higher than those in the normal volume load group,and the level of prealbumin(PAB)in the volume overload group was lower than that in normal volume load group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that age,Scr,hs-CRP/PAB,Tei index,and NT-proBNP were risk factors for volume overload in ADHF patients(P<0.05).The correlation intensity of hs-CRP/PAB and Tei index,with volume load was nonlinear dose response(P<0.01).Logistic regression model and neural network model were established to predict the probability of volume overload in ADHF patients.The area under ROC curve(AUC)of Logistic regression model and neural network model were 0.934 and 0.9

关 键 词：急性失代偿心力衰竭 超敏C反应蛋白与前清蛋白比值 TEI指数 容量负荷 

分 类 号：R54[医药卫生—心血管疾病]