C-反应蛋白/白蛋白比值联合血小板计数和格拉斯哥昏迷评分对热射病预后的评估价值  

Evaluation value of C-reactive protein/albumin ratio combined with platelet count and Glasgow coma scale for prognosis of patients with heat stroke

作　　者：石珊珊 吴征臻 黄勇 符祥雷 Shi Shanshan;Wu Zhengzhen;Huang Yong;Fu Xianglei(Clinical Medicine School of North Sichuan Medical College,Nanchang 637000,Sichuan,China;Department of Emergency Medicine,Nanchong Center Hospital,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院临床医学院,四川南充637000 [2]南充市中心医院急诊医学科,四川南充637000

出　　处：《中华危重病急救医学》2025年第2期160-164,共5页Chinese Critical Care Medicine

摘　　要：目的探讨C-反应蛋白(CRP)/白蛋白(Alb)比值联合血小板计数(PLT)和格拉斯哥昏迷评分(GCS)对热射病(HS)患者预后的评估价值。方法回顾性分析2020年5月1日至2023年10月31日南充市中心医院重症监护病房(ICU)收治的HS患者的临床资料,包括一般资料、入院GCS评分、实验室指标和28 d预后。比较不同预后两组患者上述指标的差异;将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归分析,筛选HS患者28 d死亡的影响因素;采用受试者工作特征曲线(ROC曲线)分析各影响因素对HS患者28 d预后的预测价值。结果共纳入73例HS患者,其中28 d存活41例,死亡32例。不同预后两组HS患者间性别和年龄比较差异均无统计学意义。死亡组患者白细胞计数(WBC)、中性粒细胞计数(NEU)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、CRP水平和CRP/Alb比值显著高于存活组,入院GCS评分、血小板计数(PLT)、总胆红素(TBil)、Alb水平显著低于存活组〔WBC(×10^(9)/L):14.80(11.44,17.15)比11.96(9.47,14.82),NEU(×10^(9)/L):13.05(8.56,15.67)比9.50(6.68,12.09),AST(U/L):108.00(52.70,291.50)比64.50(38.25,110.50),ALT(U/L):62.00(19.50,159.00)比34.50(20.75,70.75),CRP(mg/L):22.49(3.42,58.93)比3.68(1.01,11.46),CRP/Alb比值:0.53(0.08,1.77)比0.08(0.02,0.44),GCS评分(分):7.0(5.0,8.0)比8.5(7.0,11.0),PLT(×10^(9)/L):107.00(73.50,126.00)比131.50(107.50,176.25),TBil(mmol/L):15.60(10.00,25.30)比21.40(14.80,30.05),Alb(g/L):32.65(32.53,49.30)比38.70(36.20,40.40),均P<0.05〕。二元Logistic回归分析显示,GCS评分〔优势比(OR)=0.686,95%可信区间(95%CI)为0.491~0.959,P=0.028〕、PLT(OR=0.973,95%CI为0.954~0.992,P=0.005)、NEU(OR=1.312,95%CI为1.072~1.606,P=0.009)和CRP/Alb比值(OR=7.652,95%CI为1.632~35.881,P=0.010)是HS患者28 d死亡的独立影响因素。ROC曲线分析显示,GCS评分、PLT、CRP/Alb比值单一预测HS患者28 d预后的曲线下面积(AUC)分别为0.705、0.752、0.729;三者联合预测HS患者28 dObjective To explore the prognostic value of C-reactive protein(CRP)/albumin(Alb)ratio combined with platelet count(PLT)and Glasgow coma score(GCS)in patients with heat stroke(HS).Methods A retrospective analysis was conducted on the clinical data of HS patients admitted to the department of intensive care unit(ICU)of Nanchong Central Hospital from May 1,2020 to October 31,2023.This included general information,admission GCS,laboratory indicators and 28-day prognosis.The differences in the above indicators were compared between two groups of patients with different prognoses.Statistically significant indicators from univariate analysis were included in multivariate Logistic regression analysis to screen for factors influencing 28-day mortality in HS patients.The predictive value of various influencing factors on the 28 days prognosis of HS patients were analyzed by receiver operator characteristic curve(ROC curve).Results A total of 73 HS patients were included,of whom 41 survived for 28-day and 32 died.There were no statistically significant differences in gender and age between the two groups of HS patients with different prognoses.The white blood cell count(WBC),neutrophil count(NEU),aspartate aminotransferase(AST),alanine aminotransferase(ALT),CRP,and CRP/Alb ratio in the death group were significantly higher than those of the survival group,and the admission GCS score,platelet count(PLT),total bilirubin(TBil)and Alb were significantly lower than the survival group[WBC(×10^(9)/L):14.80(11.44,17.15)vs.11.96(9.47,14.82),NEU(×10^(9)/L):13.05(8.56,15.67)vs.9.50(6.68,12.09),AST(U/L):108.00(52.70,291.50)vs.64.50(38.25,110.50),ALT(U/L):62.00(19.50,159.00)vs.34.50(20.75,70.75),CRP(mg/L):22.49(3.42,58.93)vs.3.68(1.01,11.46),CRP/Alb ratio:0.53(0.08,1.77)vs.0.08(0.02,0.44),GCS score:7.0(5.0,8.0)vs.8.5(7.0,11.0),PLT(×10^(9)/L):107.00(73.50,126.00)vs.131.50(107.50,176.25),TBil(mmol/L):15.60(10.00,25.30)vs.21.40(14.80,30.05),Alb(g/L):32.65(32.53,49.30)vs.38.70(36.20,40.40),all P<0.05].Binary Logistic regression analysis

关 键 词：热射病 C-反应蛋白/白蛋白比值 格拉斯哥昏迷评分 血小板计数 预后 

分 类 号：R459.7[医药卫生—急诊医学]