Predictive value of four items of inflammation for the severity of ulcerative colitis
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摘要: 目的 探讨炎症四项[C反应蛋白(C-reaction protein，CRP)、IL-6、血清淀粉样蛋白A(serum amyloid A，SAA)、降钙素原(procalcitonin，PCT)]在预测溃疡性结肠炎(ulcerative colitis，UC)严重程度方面的应用价值。方法 选取2020年12月—2023年12月在安徽中医药大学第一附属医院肛肠科住院治疗的UC患者为研究对象，将80例轻度患者设为对照组，155例中重度患者设为观察组。收集患者的临床资料及炎症四项数据。采用多因素logistic回归分析研究UC严重程度的影响因素，采用ROC曲线分析炎症四项对UC严重程度的预测效果。结果 观察组WBC、RBC、纤维蛋白原、CRP、IL-6、PCT、SAA均高于对照组(均P < 0.001)，血清白蛋白低于对照组(P < 0.001)。多因素logistic回归分析结果显示，CRP、IL-6、PCT、SAA是UC严重程度的独立影响因素(P < 0.001)。ROC曲线分析结果显示，CRP、IL-6、PCT、SAA及四者联合预测中重度UC的AUC分别为0.791、0.728、0.781、0.751、0.895；四者联合预测中重度UC的AUC均大于CRP、IL-6、PCT、SAA单独预测的AUC(均P < 0.001)。结论 CRP、IL-6、PCT、SAA是UC严重程度的独立影响因素，且四者联合预测UC严重程度具备较高临床价值。Abstract: Objective This study will definitively determine the predictive value of inflammatory components, including C-reaction protein(CRP), procalcitonin(PCT), serum amyloid A(SAA), and IL-6, in identifying the severity of ulcerative colitis(UC).Methods This research recruited UC patients who were hospitalized in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from December 2020 to December 2023 of these, 155 patients with moderate severity were placed in the observation group and 80 patients with mild severity were placed in the control group. Four data sets on inflammation and general patient information were gathered. ROC curves were utilized to analyze the prediction power of the four inflammatory indicators on the severity of UC, and multifactorial logistic regression analysis was employed to investigate the factors influencing UC severity.Results Leukocyte count, erythrocyte count, fibrinogen(Fib), CRP, IL-6, PCT, and SAA were higher in the observation group than in the control group(P < 0.001), albumin(ALB) was lower in the control group(P < 0.001). The four predictor values for moderate to severe UC were 0.791, 0.728, 0.781, 0.751, and 0.895, respectively, according to ROC curve analysis, which also revealed the values for CRP, IL-6, PCT, and SAA. The AUCs of the four combined predictors of moderate to severe UC were higher than those predicted by CRP, IL-6, PCT, and SAA alone, respectively(P < 0.001).Conclusion CRP, IL-6, PCT, and SAA are the independent factors affecting the severity of UC, and the combination of the four factors has a high value in predicting the severity of UC.
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Key words:
- ulcerative colitis /
- C-reaction protein /
- IL-6 /
- serum amyloid A /
- procalcitonin /
- predictive value
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表 1 两组患者的临床资料及血清相关指标比较
X±S，例(%)，M(P25，P75) 指标 观察组(n=155) 对照组(n=80) t/χ2/Z P 年龄/岁 45.55±14.98 44.46±15.35 -0.456 0.649 性别 0.108 0.743 男 81(52.26) 40(50.00) 女 74(47.74) 40(50.00) BMI 21.96±2.54 22.53±5.05 -0.295 0.768 病程/d 22.85±4.95 23.07±5.43 0.275 0.783 病变范围 5.348 0.253 直肠 23(14.84) 14(17.50) 直肠乙状结肠 32(20.64) 25(31.25) 左半结肠 38(24.52) 17(21.25) 全结肠 42(27.10) 19(23.75) 区域性结肠 20(12.90) 5(6.25) WBC/(×109/L) 8.07(6.51，9.63) 5.28(4.54，6.27) -8.957 < 0.001 RBC/(×109/L) 6.84(4.93，9.07) 4.43(3.82，4.68) -8.955 < 0.001 ESR/(mm/h) 14.09(9.12，20.03) 10.15(6.97，22.78) -1.158 0.114 Fib/(g/L) 3.46(2.12，4.75) 2.76(1.85，3.63) -3.365 < 0.001 ALB/(g/L) 33.99(30.98，37.68) 38.13(36.30，40.34) -5.438 < 0.001 CRP/(mg/L) 14.62(6.68，24.35) 5.47(3.56，8.26) -7.300 < 0.001 IL-6/(ng/L) 13.76(9.90，20.29) 8.58(4.66，12.20) -5.720 < 0.001 PCT/(μg/L) 1.43(1.15，1.68) 1.08(0.78，1.30) -7.052 < 0.001 SAA/(mg/L) 36.58(33.11，42.46) 30.11(25.85，36.21) -6.304 < 0.001 
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表 2 中重度UC危险因素的logistic回归分析
变量 β SE Wald χ2 P OR 95%CI CRP 0.178 0.031 32.572 < 0.001 1.195 1.124~1.270 IL-6 2.007 0.384 27.276 < 0.001 7.439 3.503~15.797 PCT 0.221 0.036 38.574 < 0.001 1.247 1.163~1.337 SAA 0.148 0.025 34.700 < 0.001 1.159 1.104~1.218
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表 3 CRP、IL-6、PCT、SAA及四项联合对中重度UC的预测价值
指标 AUC 灵敏度 特异度 最佳截断值 95%CI P CRP 0.791 0.639 0.838 10.180 mg/L 0.791~0.847 < 0.001 IL-6 0.728 0.645 0.725 11.600 ng/L 0.728~0.797 < 0.001 PCT 0.781 0.768 0.637 1.135 μg/L 0.781~0.840 < 0.001 SAA 0.751 0.819 0.613 31.625 mg/L 0.751~0.818 < 0.001 四项联合 0.895 0.903 0.712 0.895~0.934 < 0.001
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