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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 426 -431. doi: 10.3877/cma.j.issn.2095-2015.2024.05.009

论著

纤维蛋白原与清蛋白比值、中性粒细胞与白蛋白比值、C反应蛋白与溃疡性结肠炎病情评估和预后的关系
孙文恺1, 沈青1,†(), 杭丽1, 张迎春1   
  1. 1. 215600　江苏省，南京中医药大学附属张家港市中医医院脾胃病科
  • 收稿日期:2024-01-26 出版日期:2024-10-01
  • 通信作者: 沈青

Relationship of FAR, NAR, CRP with the evaluation and prognosis of ulcerative colitis patients

Wenkai Sun1, Qing Shen1,†(), Li Hang1, Yingchun Zhang1   

  1. 1. Department of Spleen and Stomach Diseases, Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, China
  • Received:2024-01-26 Published:2024-10-01
  • Corresponding author: Qing Shen
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引用本文：

孙文恺, 沈青, 杭丽, 张迎春. 纤维蛋白原与清蛋白比值、中性粒细胞与白蛋白比值、C反应蛋白与溃疡性结肠炎病情评估和预后的关系[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 426-431.

Wenkai Sun, Qing Shen, Li Hang, Yingchun Zhang. Relationship of FAR, NAR, CRP with the evaluation and prognosis of ulcerative colitis patients[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 426-431.

目的

探讨溃疡性结肠炎（UC）患者纤维蛋白原与清蛋白比值（FAR）、C反应蛋白（CRP）、中性粒细胞与白蛋白比值（NAR）情况及其与病情和预后的关系。

方法

回顾性分析2020年11月1日至2022年12月31日在南京中医药大学附属张家港市中医医院治疗的102例UC患者为研究组，根据改良Mayo内镜评分将UC患者分为缓解组、轻度组、中度组和重度组，选取同期100名健康人作为对照组。随访观察UC患者发生癌变情况，根据有无癌变分为癌变组和非癌变组。对比各组相关临床指标水平，采用logistic回归和受试者工作曲线（ROC）分析FAR、CRP、NAR对UC患者病情活动性及预后的关系。

结果

研究组体重指数（BMI）低于对照组，白细胞总数、血小板、红细胞沉降率（ESR）、FAR、CRP、NAR明显高于对照组（P<0.05）。在不同病情亚组中，BMI、白细胞计数、血小板计数、ESR、FAR、CRP、NAR对比，差异有统计学意义（P<0.05）。多因素logistic回归分析提示，白细胞计数、血小板计数、ESR、FAR、CRP、NAR是影响UC病情严重程度的独立因素（P<0.05）。白细胞、血小板、ESR、FAR、CRP、NAR评估UC患者病情，ROC结果显示曲线下面积分别为0.730、0.694、0.830、0.826、0.874、0.832；随访后发现共有5例（2.37%）UC患者发生癌变，白细胞、ESR、NAR与UC患者是否癌变具有相关性（P<0.05）；白细胞、ESR、NAR预测UC患者是否癌变的ROC分析提示，曲线下面积分别为0.808、0.811、0.825（P<0.05）。

结论

FAR、CRP、NAR评估UC患者病情具有良好价值，NAR在预测UC患者是否癌变具有良好价值。

关键词: 结肠炎，溃疡性, 纤维蛋白原与清蛋白比值, 中性粒细胞与白蛋白比值, C反应蛋白, 病情评估, 预后
Objective

To explore the fibrinogen to albumin ratio (FAR), C-reactive protein (CRP), neutrophil to albumin ratio (NAR) of ulcerative colitis (UC) patients and their relationship with the condition and prognosis.

Methods

A retrospective analysis was conducted on the clinical data of 102 patients with UC treated in Zhangjiagang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from November 1, 2020 to December 31, 2022. The study group was divided into relief group, mild group, moderate group, and severe group according to the modified Mayo endoscopic score, and 100 healthy individuals during the same period were selected as the control group. Patients with UC were followed up to observe the occurrence of cancer, and were divided into cancer group and non-cancer group based on the presence or absence of cancer. The levels of relevant clinical indicators in each group were compared, and logistic regression and receiver operating curve (ROC) were used to analyze the relationship between FAR, CRP and NAR and the activity and prognosis of UC patients.

Results

The study group had lower BMI than the control group, but significantly higher white blood cell count, platelet count, erythrocyte sedimentation rate (ESR), FAR, CRP, and NAR than the control group, with statistically significant differences (P<0.05). The differences in BMI, white blood cell count, platelet count, ESR, FAR, CRP, and NAR among different disease subgroups were statistically significant (P<0.05). Multivariate logistic regression analysis showed that white blood cell count, platelet count, ESR, FAR, CRP, and NAR were independent factors affecting the severity of UC (P<0.05). White blood cells, platelets, ESR, FAR, CRP, and NAR were used to evaluate the condition of UC patients, and the ROC results showed that the area under the curve was 0.730, 0.694, 0.830, 0.826, 0.874, and 0.832, respectively. After follow-up, it was found that a total of 5 cases (2.37%) of UC patients developed cancer. There was a correlation between white blood cell count, ESR, NAR, and whether UC patients had cancer (P<0.05). The ROC analysis results of white blood cells, ESR, and NAR predicting cancer progression in UC patients indicated that the area under the curve was 0.808,0.811 and 0.825, respectively, with statistically significant differences (P<0.05).

Conclusion

FAR, CRP, and NAR have good value in evaluating the condition of UC patients, and NAR has good value in predicting whether UC patients will undergo cancer.

Key words: Ulcerative colitis, Fibrinogen to albumin ratio, Neutrophil to albumin ratio, C-reactive protein, Disease assessment, Prognosis
表1 研究组与对照组基线资料情况比较
组别 例数 性别[例(%)] 年龄(岁,±s) 民族[例(%)]
男 女 汉族 其他
研究组 102 55(53.92) 47(46.08) 46.93±9.55 81(80.20) 20(19.80)
对照组 100 57(57.00) 43(43.00) 45.33±8.48 85(85.00) 15(15.00)
χ2/t值   0.190 1.429 0.806
P值   0.660 0.154 0.369
表2 研究组与对照组临床资料比较（±s）
组别 例数 BMI(kg/m2) 白细胞(×109/L) 血小板(×109/L) ESR(mm/1 h) FAR CRP(mg/L) NAR
研究组 102 18.87±3.95 8.79±2.08 273.68±56.02 27.68±6.47 77.68±15.49 13.68±3.93 10.17±2.26
对照组 100 21.64±4.49 5.38±1.17 201.74±43.79 10.26±2.24 62.32±17.61 4.18±1.07 7.26±1.87
t值   -4.658 14.322 10.155 25.468 6.586 23.339 9.960
P值   0.000 0.000 0.000 0.000 0.000 0.000 0.000
表3 不同病情亚组检验指标比较（±s）
组别 例数 BMI(kg/m2) 白细胞(×109/L) 血小板(×109/L) ESR(mm/h) FAR CRP(mg/L) NAR
缓解组 12 19.85±4.18 6.67±1.08 246.27±62.40 8.79±2.37 63.58±11.38 7.20±1.87 8.27±1.17
轻度组 28 19.71±4.53 7.12±2.11 256.19±52.39 15.79±3.89 70.27±14.48 9.32±2.21 9.37±2.29
中度组 38 18.38±3.88 9.40±2.36 287.58±51.28 37.94±8.87 83.05±17.16 13.21±4.59 10.38±2.17
重度组 24 18.17±3.27 10.83±2.1 295.28±64.57 34.75±7.73 84.87±16.08 22.75±5.92 11.72±2.91
F值   1.127 18.242 3.751 92.321 8.546 56.167 7.493
P值   0.353 0.000 0.013 0.000 0.000 0.000 0.000
表4 不同临床指标对溃疡性结肠炎病情影响的多因素logistic回归分析
指标 赋值情况 β S.E Wald P OR 95% CI
BMI(kg/m2) <18.87=0；≥18.87=1 -0.126 0.001 3.501 0.061 0.882 0.836~0.946
白细胞(×109/L) <8.79=0；≥8.79=1 0.033 0.015 14.497 0.000 1.033 1.012~1.044
血小板(×109/L) <273.68=0；≥273.68=1 0.201 0.041 9.703 0.002 1.223 1.167~1.396
ESR(mm/1 h) <27.68=0；≥27.68=1 0.027 0.088 15.908 0.000 1.027 1.022~1.034
FAR <77.68=0；≥77.68=1 0.014 0.029 10.807 0.000 1.014 1.011~1.018
CRP(mg/L) <13.68=0；≥13.68=1 0.033 0.011 22.489 0.000 1.033 1.012~1.053
NAR <10.17=0；≥10.17=1 0.208 0.045 17.347 0.000 1.231 1.215~1.476
图1 不同临床指标预测溃疡性结肠炎病情的ROC曲线
表5 不同临床指标预测溃疡性结肠炎病情的价值
指标 曲线下面积 S.E 灵敏度(%) 特异性(%) 95% CI P
白细胞 0.730 0.033 70.00 61.54 0.664~0.797 <0.001
血小板 0.694 0.035 51.67 72.53 0.624~0.764 <0.001
ESR 0.830 0.028 63.33 97.80 0.776~0.884 <0.001
FAR 0.826 0.027 65.83 92.31 0.772~0.881 <0.001
CRP 0.874 0.024 70.83 94.51 0.828~0.921 <0.001
NAR 0.832 0.027 63.33 98.90 0.779~0.885 <0.001
表6 不同临床指标与溃疡性结肠炎是否癌变的相关性（±s）
组别 例数 BMI(kg/m2) 白细胞(×109/L) 血小板(×109/L) ESR(mm/h) FAR CRP(mg/L) NAR
癌变组 3 17.55±3.25 12.16±2.31 299.60±60.36 38.37±7.69 89.07±16.98 15.59±3.88 15.48±3.38
非癌变组 99 18.91±3.97 8.69±2.07 272.89±55.89 27.36±6.43 77.33±15.44 13.62±3.93 10.01±2.26
t值   -0.586 2.853 0.814 2.909 1.295 0.856 4.08
P值   0.559 0.005 0.418 0.004 0.198 0.394 0
图2 不同临床指标预测溃疡性结肠炎癌变的ROC曲线
表7 不同临床指标预测溃疡性结肠炎癌变的价值
指标 曲线下面积 S.E 灵敏度(%) 特异性(%) 95% CI P值
白细胞 0.808 0.050 72.82 80.00 0.711~0.905 0.018
ESR 0.811 0.049 97.09 80.00 0.716~0.907 0.011
NAR 0.825 0.080 67.48 80.00 0.668~0.982 0.014
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