CRP与白蛋白比值在婴幼儿重症肺炎病情及预后评估中的价值

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摘要目的：观察婴幼儿重症肺炎患者入院血清C反应蛋白（CRP）、血清白蛋白及其比值与死亡预后的关系，探讨其能否作为评估病情及判断预后的指标。方法：回顾性分析73例婴幼儿重症肺炎患者临床资料，根据28 d生存情况分为：存活组与死亡组，根据小儿危重病例评分（PCIS）分为：为非危重组、危重组与极危重组，分别比较各组间血清CRP、白蛋白水平及CRP/白蛋白比值差异以及预测重症肺炎患儿预后的价值。结果：重症肺炎患儿28 d死亡20例，存活53例。死亡组与存活组间血清CRP、白蛋白以及CRP/白蛋白比值差异均有统计学意义（P＜0.05）。ROC曲线分析提示，CRP、白蛋白及CRP/白蛋白曲线下面积分别为0.877、0.840和0.841，CRP/白蛋白取0.5为截点值时，其灵敏度和特异度分别为85.0%、77.4%；CRP取16.5 mg/L为截点值时，其灵敏度和特异度分别为80.0%、73.6%；白蛋白取33.0 g/L为截点值时，其灵敏度和特异度分别为77.4%、75.0%。结论：CRP/白蛋白比值、CRP和白蛋白对婴幼儿重症肺炎病情评估及死亡预测有一定价值，且CRP/白蛋白比值的预测准确性明显优于CRP和白蛋白。

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	孙亨秋

关键词 ：重症肺炎, C反应蛋白质, 血清白蛋白, ROC曲线, 预后

Abstract：Objective: To evaluate the role of CRP, albumin and CRP/albumin ratio in predicting the outcome of severe pneumonia in infants. Methods: Altogether 73 patients with severe pneumonia were enrolled in this study and divided into survival group and death group according to 28-day mortality, and further divided into non-risk group, risk group and high-risk group according to the PCIS score. Serum CRP, albumin and PCIS score within 24 hours after admission were recorded. The CRP, albumin, CRP/albumin ratio were compared between survival group and death group. Results: The 28-day mortality was 27.4%. There was significant difference between survival group and death group in CRP, albumin and CRP/albumin ratio. Receiver operating characteristic curves showed the area under the curve of CRP/albumin ratio, CRP and albumin for 28-day mortality were 0.877 (P<0.05), 0.840 (P<0.05) and 0.841 (P<0.05), respectively. When the cut-off of CRP/albumin ratio was 0.5, the sensitivity and specificity were 85.0% and 77.4% respectively; when the cut-off of CRP was 16.5 mg/L, the sensitivity and specificity were 80.0% and 73.6% respectively. When the cut-off of albumin was 33.0 g/L, the sensitivity and specificity were 77.4% and 75.0% respectively. Conclusion: The CRP/albumin ratio, CRP and albumin were independent predictors of 28-day mortality in infants with severe pneumonia. The CRP/albumin ratio was better than CRP and albumin alone.

Key words： severe pneumonia c-reactive protein serum albumin ROC curve prognosis

收稿日期: 2017-11-19

作者简介: 孙亨秋（1984-），男，浙江温岭人，主治医师。

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https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I3/220

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