通讯作者: 杨林瀛, 15633142970@163.com

DOI：10.12201/bmr.202412.00057

The predictive value of FAP/ALB and NLPR in predicting the severity of CAP in the elderly

• 摘要：【摘要】　目的　探讨纤维蛋白降解产物与白蛋白比值（the ratio of fibrin degradation products to albumin，FAP/ALB）、中性粒细胞与淋巴细胞及血小板比值（neutrophil to lymphocyte and platelet ratio，NLPR）对老年社区获得性肺炎严重程度的预测价值。方法　选取2021年3月-2023年3月，在承德医学院附属医院呼吸科住院的老年社区获得性肺炎（community acquired pneumonia，CAP）患者147例，根据病情严重程度分为非重症肺炎组（n=94）和重症肺炎组（n=53）。记录两组患者的一般资料和临床资料，计算中性粒细胞与淋巴细胞比值（the neutrophil to lymphocyte ratio，NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio，PLR）、C反应蛋白与白蛋白比值（C-reactive protein to albumin ratio ，CAR）、FAP/ALB、NLPR、氧合指数。对比两组上述指标的差异，并进行分析；比较FAP/ALB、NLPR与其它传统炎性指标对老年CAP严重程度的预测价值。结果　重症肺炎组C反应蛋白（C-reactive protein，CRP）、降钙素原（procalcitonin，PCT）、白细胞（white blood cells，WBC）、中性粒细胞（neutrophil，NEU）、纤维蛋白降解产物（fibrin degradation products to albumin，FDP）、NLR、CAR、CURB-65评分、FAP/ALB、NLPR明显高于非重症肺炎组，淋巴细胞（lymphocyte，LYM）、血小板（platelet，PLT）、白蛋白（albumin，ALB）明显低于非重症肺炎组（P＜0.05）；而两组年龄、性别、吸烟史、基础疾病、PLR差异均无统计学意义（P＞0.05）。Spearman相关性分析显示FAP/ALB、NLPR与CRP、PCT、WBC、NLR、CAR、CURB-65评分呈正相关性，与氧合指数呈负相关（P＜0.05）。多因素logistic回归分析显示FAP/ALB、NLPR是老年重症CAP的独立危险因素（P＜0.05）。受试者工作特征曲线（ROC）分析显示FAP/ALB、NLPR、NLR、CAR、PCT、NEU、CURB-65评分、CRP、WBC预测老年CAP严重程度的能力逐渐减低（P＜0.05）。结论　FAP/ALB、NLPR对老年CAP严重程度的预测价值明显优于目前传统炎性指标（CRP、PCT、WBC、NEU、NLR、CAR、CURB-65评分），应当引起各临床工作者重视。

  关键词： 老年社区获得性肺炎；纤维蛋白降解产物与白蛋白比值；中性粒细胞与淋巴细胞及血小板比值；预测价值; ; 

   

  Abstract: 【Abstract】　Objective　To explore the predictive value of the ratio of fibrin degradation products to albumin (F/A ratio), neutrophil to lymphocyte and platelet ratio (NLPR) for the severity of elderly CAP. Methods　147 elderly CAP patients hospitalized in the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Chengde Medical College from March 2021 to March 2023 were selected and divided into non severe pneumonia group (n=94) and severe pneumonia group (n=53) according to the severity of the disease. The general and clinical data of the two groups of patients were recorded, Calculate the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein to albumin ratio (CAR), F/A ratio, NLPR, and oxygenation index.Compare the differences between the two groups of the above indicators and conduct correlation analysis; Compare the predictive value of F/A ratio, NLPR, and other traditional inflammatory indicators on the severity of elderly CAP. Results　The C-reactive protein,procalcitonin,white blood cells,neutrophil,fibrin degradation products to albumin,the neutrophil to lymphocyte ratio,C-reactive protein to albumin ratio，CURB-65 scores, F/A ratio, and NLPR in the severe pneumonia group were significantly higher than those in the non severe pneumonia group, while lymphocyte,platelet and albumin were significantly lower than those in the non severe pneumonia group (P<0.05); There were no statistically significant differences in age, gender, smoking history, underlying diseases, and PLR between the two groups (P>0.05). Spearman correlation analysis showed a positive correlation between F/A ratio, NLPR, CRP, PCT, WBC, NLR, CAR, and CURB-65 scores, while a negative correlation with PaO2/FiO2 (P<0.05). Multivariate logistic regression analysis showed that F/A ratio and NLPR were independent risk factors for severe CAP in the elderly (P<0.05). The analysis of the receiver operating characteristic curve (ROC) showed that the ability of F/A ratio, NLPR, NLR, CAR, PCT, NEU, CURB-65 score, CRP, and WBC to predict the severity of elderly CAP gradually decreased(P<0.05). Conclusion　The predictive value of F/A ratio and NLPR for the severity of elderly CAP is significantly better than traditional inflammatory indicators (CRP, PCT, WBC, NEU, NLR, CAR, CURB-65 scores), which should be taken seriously by clinical workers.

  Key words: Elderly community acquired pneumonia; The ratio of fibrin degradation products to albumin; Ratio of neutro；phils to lymphocytes and platelets，predictive value

  提交时间：2024-12-24

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  1	2024-11-29	bmr.202412.00057V1	下载

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