目的 探讨C反应蛋白(CRP)/白蛋白(Alb)在自发性脑出血(ICH)患者病情严重程度评估及预后预测中的价值。方法 选择联勤保障部队980医院2023-01至2024-01收治的ICH患者98例作为观察组,根据病情程度分为重度组(≥15分,n=37)、中轻度组(＜15分,n=61)。根据预后结局分为预后良好组(＜3 分,n=69)、不良组(≥3分,n=29)。另选择同期接受检测的100名健康人群作为对照组。采集研究对象的一般资料,并检测入院第1、7、14天的CRP、Alb定量结果,计算CRP/Alb比值。对比观察组入院第1天与对照组的CRP、Alb及CRP/Alb比值,不同病情ICH患者入院第1、7、14天的CRP、Alb及CRP/Alb比值,不同预后ICH患者的临床特征;采用Logistic回归模型分析ICH患者不良预后的影响因素;以受试者操作特征(ROC)曲线分析CRP/Alb比值预测ICH患者预后结局效能。结果 观察组CRP、CRP/Alb比值均高于对照组,Alb低于对照组(P<0.05)。两组不同病情ICH患者入院第7、14天的CRP、CRP/Alb比值较第1天明显升高,且重度组入院第1、7、14天的CRP、CRP/Alb比值均高于中轻度组,入院第14天的Alb低于中轻度组(P<0.05)。不同预后ICH患者年龄,糖尿病,NIHSS,脑出血量,入院第1、7、14天的CRP、CRP/Alb比值,入院第7、14天的Alb对比有差异(P<0.05)。Logistic回归分析结果显示,年龄、NIHSS、脑出血量、第7天的CRP及其CRP/Alb比值为ICH患者不良预后发生的独立影响因素,入院第7天的Alb为保护因素(P<0.05)。ROC曲线结果显示,入院第7天的CRP/Alb比值预测ICH患者预后不良结局的曲线下面积(AUC)为0.845(0.752～0.938),均高于CRP、Alb单一指标(P<0.05)。结论 CRP/Alb比值可用于ICH疾病鉴别、病情评估及预后判断,且相较于单一指标,联合定量评估预测预后结局效能更高。

Objective To explore the value of C-reactive protein(CRP)/albumin(Alb) in assessing the severity and predicting the prognosis of patients with spontaneous intracerebral hemorrhage(ICH). Methods A total of 98 patients with ICH admitted to the 980th Hospital of PLA Joint Logistics Support Force from January 2023 to January 2024 were selected as the observation group,and they were divided into a severe group (≥15 points, n=37) and a moderate-to-mild group (<15 points, n=61) according to the severity of the disease. According to the prognosis outcome, they were further divided into a good prognosis group (<3 points, n=69) and a poor prognosis group (≥ 3 points, n=29). Another 100 healthy individuals who were tested during the same period were selected as the control group. The data of the research subjects were collected, and the quantitative results of CRP and Alb on the 1st, 7th, and 14th day after admission were detected. The CRP/Alb ratio was calculated. The CRP, Alb and CRP/Alb ratio of the observation group on the 1st day of admission were compared with those of the control group. The CRP, Alb, and CRP/Alb ratios of ICH patients with different conditions on the 1st, 7th, and 14th day of admission,and the clinical features of ICH patients with different prognoses were compared. Logistic regression model was used to to analyze the influencing factors of poor prognosis in ICH patients. The receiver operating characteristic (ROC) curve was used to predict the prognostic efficacy of CRP/Alb ratio in ICH patients. Results The CRP and CRP/Alb ratios in the observation group were higher than those in the control group, while Alb was lower than that in the control group (P<0.05). The CRP and CRP/Alb ratios of two groups of ICH patients with different disease severity significantly increased on the 7th and 14th day of admission compared to the 1st day, and the CRP and CRP/Alb ratios of the severe group were higher than those of the moderate-to-mild group on the 1st day, 7th and 14th day of admission, while the Alb on the 14th day of admission was lower than that of the moderate-to-mild group (P<0.05). There were differences in age, diabetes, NIHSS, cerebral hemorrhage, CRP, CRP/Alb ratio on the 1st, 7th, and 14th day after admission, and Alb on the 7th and 14th days after admission among ICH patients with different prognosis (P<0.05). The results of Logistic regression analysis showed that age, NIHSS, volume of intracerebral hemorrhage, CRP on the 7th day, and the CRP/Alb ratio were independent influencing factors for poor prognosis of ICH patients, while Alb on the 7th day was a protective factor (P<0.05). The ROC curve results showed that the area under the curve (AUC) of predicting poor prognosis in ICH patients by the CRP/Alb ratio on the 7th day of admission was 0.845(0.752-0.938), which was higher than that of CRP and Alb alone (P<0.05). Conclusions The CRP/Alb ratio can be used for the differentiation, evaluation, and prognosis of ICH disease. Compared with a single indicator, the combined quantitative evaluation has a higher predictive effect on prognosis outcomes of ICH patients.