【摘要】 目的 探讨C-反应蛋白（CRP）与血清白蛋白（ALB）比值（CRP/ALB）预测感染性休克患者发生急性呼吸窘迫综合征（ARDS）的临床价值。方法 选择浙江省人民医院重症医学科（ICU）自2015-01～2016-06收治的141例感染性休克患者为研究对象,按照入科后第7天是否发生ARDS分为ARDS组与对照组。比较两组患者入科时CRP、ALB水平和CRP/ALB,以及入科后第7天的急性生理与慢性健康状况评分Ⅱ（APACHEⅡ评分）、序贯器官衰竭评分（SOFA评分）、血乳酸（Lac）和氧合指数（OI）差异,分析入科时CRP/ALB与入科后第7天时APACHEⅡ评分、SOFA评分、Lac和OI之间的相关性,绘制CRP/ALB预测感染性休克患者发生ARDS的受试者工作特征（ROC）曲线并寻找其最佳截断点。结果 141例感染性休克患者中共46例发生ARDS,发生率为32.62%。两组患者入科时CRP及ALB水平差异无统计学意义（均P>0.05）,但ARDS组患者CRP/ALB（3.04±0.35 vs.2.39±0.29,t=4.625）明显高于对照组患者,差异有统计学意义（P<0.05）。相关性分析结果 显示,感染性休克患者入科时CRP/ALB与入科第7天时APACHEⅡ评分、SOFA评分及Lac水平呈正相关,与01呈负相关（r值分别为0.653、0.603、0.596和-0.795,均P<0.05）。ROC曲线分析显示,入科时CRP/ALB预测感染性休克患者发生ARDS的曲线下面积（AUC）为0.652（95%CI 0.553～0.750,P=0.006）,最佳截断点为2.78×10^-3,此时敏感度、特异度和约登指数分别为0.778、0.545和0.323。结论 CRP/ALB对预测感染性休克患者发生ARDS具有极高的临床价值,有助于判断病情,值得在临床中推广应用。更多还原

【Abstract】 Objective To discuss the clinical significance of the ratio( CRP/ALB) of C-reactive protein( CRP) to albumin(ALB) for predicting acute respiratory distress syndrome(ARDS) in patients with septic shock. Methods 141 cases with septic shock admitted at department of intensive care unit(ICU) of Zhejiang Provincial People’s Hospital from January 2015 to June 2016 were selected as investigation individuals and divided into the ARDS group and control group. To compare the levels of CRP, ALB and CRP/ALB at time of admission to ICU and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ score), sequential organ failure assessment score(SOFA score), lactic acid(Lac) and oxygenation index(OI) at 7 th day after admission to ICU of the two groups. To analyze the correlation between the CRP/ALB at time of admission to ICU and the APACHE Ⅱ score, SOFA score,Lac and OI at 7 th day after admission to ICU and draw the receiver-operating characteristic curve( ROC curve) of CRP/ALB for predicting ARDS and find the best cut-off score. Results Of the 141 cases with septic shock, the incidence rate of ARDS was 32. 62%(46/141). There were no statistical significances about levels of CRP and ALB at time of admission to ICU( all P > 0.05), while the CRP/ALB(3.04 ±0.35 vs. 2.39 ±0.29, t=4.625)of the ARDS group was significantly higher than that of the control group, the difference was statistically significant(P <0. 05). At 7 th day after admission to ICU the APACHE Ⅱ score(25.24±5.84 vs. 17.65±4.26, t=4.563), SOFA score(4.25±1.36 vs. 2.03 ±0.95, t=3. 685) and Lac(3. 04 ± 0.35 vs. 2. 39 ± 0. 29, t = 4. 625) of the ARDS group were significantly higher than those of the control group, while the OI(243. 15 ±36.52 vs. 305. 62 ±39.45, t=-3. 752) was obviously lower than that of the control group, differences were all statistically significant(all P<0. 05). Correlation analysis showed that the CRP/ALB at time of admission to ICU was positively correlated with the APACHE Ⅱ score, SOFA score and level of Lac while negatively correlated with OI of at 7 th day after admission to ICU( r values were respectively 0. 653, 0. 603, 0. 596 and-0. 795, all P <0. 05). Conclusion The CRP/ALB has a high clinical value for predicting ARDS in patients with septic shock. It can help to evaluate the illness state and is worth popularizing in clinical application.更多还原