The relationship between C-reactive protein/albumin ratio and disease activity in patients with inflammatory bowel disease
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摘要: 目的 探讨C反应蛋白/白蛋白比值(CRP/ALB)、炎症标志物和全血计数水平与炎症性肠病(IBD)活动性的相关性。方法 将2015年1月—2020年12月诊治的584例IBD患者纳入研究，其中溃疡性结肠炎(UC)183例，克罗恩病(CD)401例，分析血清CRP、ALB、血沉(ESR)和全血计数与IBD的关系，采用Mayo评分和Crohn疾病活动指数分别评估UC和CD患者的疾病活动性。结果 活动期IBD患者的CRP/ALB比值、CRP、ESR、血小板/淋巴细胞比值(PLR)、红细胞分布宽度、中性粒细胞/淋巴细胞比值(NLR)明显高于缓解期，而ALB和淋巴细胞/单核细胞比值(LMR)明显低于缓解期(P< 0.05)。受试者工作特征曲线分析结果显示，活动期UC和CD的CRP/ALB比值的最佳截断值分别为0.17和0.42，敏感性分别为67.9%和75.7%，特异性分别为86.5%和92.1%。多因素logistic回归分析显示，在调整炎症标志物(ESR、NLR、PLR和LMR)后，CRP/ALB比值在区分UC和CD疾病活动性上差异有统计学意义(P< 0.001)。结论 CRP/ALB比值水平与IBD疾病活动性密切相关，可用于UC和CD疾病活动性的评估。
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关键词:
- 炎症性肠病 /
- C反应蛋白/白蛋白比值 /
- 疾病活动性 /
- 敏感性 /
- 特异性
Abstract: Objective To evaluate the C-reactive protein/albumin ratio(CRP/ALB), inflammatory markers, and complete blood count parameters in patients with inflammatory bowel disease(IBD) and their relationship with disease activity.Methods A total of 584 patients with IBD treated in our hospital from January 2015 to December 2020 were included, including 183 cases of ulcerative colitis(UC) and 401 cases of Crohn's disease(CD). The relationship between serum C-reactive protein(CRP), albumin(ALB), erythrocyte sedimentation rate(ESR) and whole blood count and IBD was analyzed. The Mayo score and Crohn's disease activity index were used to evaluate the disease activity of UC and CD patients, respectively. The relationship between the above parameters and disease activity was discussed.Results The CRP/ALB ratio, CRP, ESR, platelet/lymphocyte ratio(PLR), red blood cell distribution width, neutrophil/lymphocyte ratio(NLR) of patients with active IBD were significantly higher than those of patients with stable IBD, while ALB and lymphocyte/monocyte ratio(LMR) were significantly lower than that of patients with stable IBD(P< 0.05). ROC curve analysis results showed that the best cut-off values of CRP/ALB ratio for active UC and CD were 0.17 and 0.42, respectively, the sensitivity was 67.9% and 75.7%, and the specificity was 86.5% and 92.1%, respectively. Multivariate logistic regression analysis showed that after adjusting these inflammatory markers(ESR, NLR, PLR and LMR), the CRP/ALB ratio was a statistically significant parameter to distinguish the disease activity of UC and CD(P< 0.001).Conclusion The CRP/ALB ratio is closely related to IBD disease activity. -
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表 1 UC和CD患者的临床特征
临床特征 UC患者(183例) CD患者(401例) 年龄/岁 47(36~61) 28(22~33) 男: 女/例 103:80 289:112 吸烟: 不吸烟/例 32:151 63:338 BMI 20.11(18.44~
21.28)19.29(17.44~ 20.90) 病程/月 15.79(6.00~48.00) 22.31(7.30~ 43.88) 缓解期/例(%) 65(35.5) 199(49.6) 活动期/例(%) 118(64.5) 202(50.4) 疾病部位/例(%) 直肠 32(17.5) 0 左半结肠 84(45.9) 0 全结肠 67(36.6) 0 回肠末端 0 95(23.7) 结肠 0 79(19.7) 回结肠 0 227(56.6) 用药史/例(%) 皮质类固醇 67(36.7) 178(44.4) 5-ASA 156(85.2) 312(77.8) 免疫抑制剂 21(11.5) 189(47.1) 生物制剂 15(8.2) 224(55.9) 
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表 2 UC患者活动期和缓解期的临床特征比较
临床特征 UC活动期(118例) UC缓解期(65例) 年龄/岁 49(37~61) 46.5(33~61) 男: 女/例 67:51 33:32 吸烟: 不吸烟/例 20:98 11:54 BMI 19.26(18.27~20.81) 20.65(18.83~21.89)1) ESR/(mm·h-1) 21(11.5~37.5) 7(3~18)1) CRP/(mg·L-1) 12.80(3.55~32.15) 2.97(1.36~4.19)1) ALB/(g·L-1) 34.3±5.8 41.5±4.61) CRP/ALB 0.35(0.10~0.96) 0.07(0~0.11)1) 中性粒细胞/(×109·L-1) 4.50(3.42~7.03) 3.56(2.70~4.93)1) 单核细胞/(×109·L-1) 0.70(0.46~0.92) 0.49(0.38~0.65)1) 淋巴细胞/(×109·L-1) 1.66(1.33~2.30) 1.89(1.52~2.49) 血红蛋白/(g·L-1) 118(104~133) 132(121~139)1) 平均红细胞体积/fl 88.70(82.70~92.60) 89.00(86.57~93.20)1) RDW/% 14.30(13.45~15.15) 13.40(12.70~14.50)1) 血小板计数/(×109·L-1) 283(210~375) 235(198~285)1) 平均血小板体积/fl 9.7(9.3~11.0) 10.5(9.6~11.3) NLR 2.85(1.78~4.21) 1.86(1.37~2.81)1) PLR 163.52(121.58~222.23) 122.84(92.35~168.54)1) LMR 2.67(1.80~3.50) 4.16(3.17~5.14)1) 与UC活动期比较，1)P < 0.05。
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表 3 CD患者活动期和缓解期的临床特征比较
临床特征 CD活动期(202例) CD缓解期(199例) 年龄/岁 26(22~35) 27(22~31) 男: 女/例 148:54 144:55 吸烟: 不吸烟/例 34:168 26:173 BMI 18.20(16.55~20.15) 19.60(18.25~21.60)1) ESR/(mm·h-1) 30.6(17~47) 6.9(2~14)1) CRP/(mg·L-1) 30.50(14.60~59.80) 3.10(1.79~9.10)1) ALB/(g·L-1) 32.1±5.1 42.1±4.51) CRP/ALB 0.89(0.43~1.85) 0.08(0.04~0.24)1) 中性粒细胞/(×109·L-1) 5.03(3.48~7.09) 3.47(2.51~4.53)1) 单核细胞/(×109·L-1) 0.68(0.46~0.90) 0.53(0.39~0.67)1) 淋巴细胞/(×109·L-1) 1.26(0.90~1.77) 1.59(1.13~1.85)1) 血红蛋白/(g·L-1) 113(101~126) 136(126~149)1) 平均红细胞体积/fl 83.45(78.60~87.60) 88.90(84.80~92.80)1) RDW/% 14.70(13.30~16.73) 13.60(12.70~15.70)1) 血小板计数/(×109·L-1) 328.5(253.8~415.5) 243(206~284)1) 平均血小板体积/fl 9.4(8.8~10.5) 10.7(10.0~11.6)1) NLR 4.05(2.78~6.17) 2.15(1.57~3.21)1) PLR 265.84(192.18~368.62) 163.61(118.72~234.00)1) LMR 1.79(1.36~2.58) 3.15(2.27~4.35)1) 与CD活动期比较，1)P < 0.05。
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表 4 UC和CD患者各参数与疾病活动性的Spearman相关性分析
参数 Mayo评分r CDAI r ESR 0.411 0.650 CRP 0.597 0.734 ALB -0.682 -0.745 CRP/ALB 0.625 0.761 中性粒细胞 0.329 0.367 单核细胞 0.352 0.263 淋巴细胞 -0.205 -0.239 血红蛋白 -0.401 -0.597 平均红细胞体积 -0.215 -0.391 RDW 0.338 0.369 血小板计数 0.246 0.371 平均血小板体积 -0.147 -0.451 NLR 0.395 0.453 PLR 0.349 0.443 LMR -0.497 -0.456
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表 5 UC和CD患者的多因素logistic回归分析
参数 B P OR 95%CI UC CRP/ALB 0.309 < 0.001 1.361 1.147~1.618 ESR 0.022 0.087 1.025 0.994~1.042 NLR -0.095 0.314 0.921 0.783~1.085 PLR 0.005 0.158 1.003 0.997~1.005 LMR -0.249 0.003 0.782 0.667~0.918 CD CRP/ALB 0.452 < 0.001 1.567 1.412~1.739 ESR 0.028 0.001 1.028 1.013~1.049 NLR 0.150 0.025 1.175 1.017~1.353 PLR 0.001 0.237 1.002 0.997~1.003 LMR -0.032 0.658 0.967 0.841~1.112
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表 6 CRP/ALB等炎症标志物对UC活动期与缓解期鉴别的准确性
参数 AUC SE 95%CI 截断值 敏感性/% 特异性/% CRP/ALB 0.826 0.025 0.776~0.871 0.17 67.9 86.5 CRP 0.803 0.027 0.756~0.851 5.37 80.5 70.3 ALB 0.846 0.023 0.795~0.887 38.30 73.7 80.5 ESR 0.737 0.032 0.685~0.792 15.10 67.7 72.6 NLR 0.667 0.035 0.607~0.723 2.41 57.2 70.5 PLR 0.661 0.033 0.601~0.715 187.67 42.3 86.8 LMR 0.753 0.031 0.696~0.803 3.57 76.9 69.5
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表 7 CRP/ALB等炎症标志物对CD活动期与缓解期鉴别的准确性
参数 AUC SE 95%CI 截断值 敏感性/% 特异性/% CRP/ALB 0.926 0.010 0.903~0.942 0.42 75.7 92.1 CRP 0.912 0.012 0.882~0.935 14.60 76.3 88.5 ALB 0.896 0.014 0.864~0.915 36.70 80.2 83.6 ESR 0.853 0.017 0.826~0.875 20.80 69.8 88.2 NLR 0.765 0.019 0.725~0.797 3.34 65.8 75.8 PLR 0.743 0.021 0.711~0.783 191.25 76.5 60.7 LMR 0.757 0.019 0.718~0.787 2.69 78.9 61.7
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