Predictive value and influence of C-reactive protein/albumin on renal insufficiency in patients with diabetic kidney disease
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摘要: 目的 分析C反应蛋白(CRP)、血清白蛋白(ALB)及C反应蛋白/血清白蛋白(CAR)对糖尿病肾病(DKD)肾功能不全的预测价值。方法 选取2015年4月至2020年10月，静安区、杨浦区中心医院就诊治疗的DKD患者97例，根据肾小球滤过率(e-GFR)是否 < 60 mL/(min·1.73 m2)，将患者分为肾功能不全组(53例)和非肾功能不全组(44例)，比较CRP、ALB、CAR对肾功能不全的预测价值。结果 CRP、CAR对肾功能不全预测的曲线下面积(AUC)分别为0.717、0.776，ALB预测非肾功能不全的AUC为0.714，CAR预测价值高于CRP、ALB，差异有统计学意义(P< 0.05)。CAR≥0.37与CAR < 0.37的DKD患者间病程、e-GFR、肾功能不全占比、尿酸(UA)、CRP、ALB、CAR、空腹血糖(FPG)、血红蛋白(Hb)、中性粒细胞/淋巴细胞(NLR)、白细胞计数(WBC)比较，差异均有统计学意义(均P< 0.05)。单因素分析显示，肾功能不全和非肾功能不全组间病程、e-GFR、UA、CRP、ALB、CAR、CAR≥0.37占比、Hb、NLR差异有统计学意义(P< 0.05)。二元logistic回归分析显示，CAR≥0.37、病程、NRL均为DKD患者肾功能不全的独立影响因素(均P< 0.05)。纠正混杂因素后CAR≥0.37为DKD患者肾功能不全的影响因素(P< 0.05)，而CRP、ALB均不是DKD患者肾功能不全的影响因素。结论 CAR≥0.37对DKD患者肾功能不全的预测价值高于CRP、ALB，且CAR≥0.37为肾功能不全独立的影响因素。Abstract: Objective To analyze the predictive value of C-reactive protein(CRP), serum albumin(ALB) and CRP/ALB(CAR) on renal insufficiency in patients with diabetic nephropathy(DKD).Methods A total of 97 patients with DKD treated in Jing'an District, Yangpu District Central Hospital from April 2015 to October 2020 were selected. According to whether the glomerular filtration rate(e-GFR) was less than 60 mL/(min·1.73 m2), all patients were divided into renal insufficiency group(53 cases) and non-renal insufficiency group(44 cases). The predictive value and influence of CRP, ALB and CAR on renal insufficiency were compared.Results The areas under the curve(AUC) of CRP and CAR in predicting renal insufficiency were 0.717 and 0.776 respectively, and the AUC of ALB in predicting non-renal insufficiency was 0.714. The predictive value of CAR was higher than that of CRP and ALB(allP< 0.05). There were significant differences in disease course, e-GFR, proportion of renal insufficiency, uric acid(UA), CRP, ALB, CAR, fasting plasma glucose(FPG), hemoglobin(Hb), neutrophil/lymphocyte(NLR) and white blood cell count(WBC) between DKD patients with CAR≥0.37 and CAR < 0.37(P< 0.05). Binary logistic regression analysis showed that CAR≥0.37, course of disease and NRL were independent influencing factors of renal insufficiency in the patients with DKD(P< 0.05). After correcting confounding factors, CAR≥0.37 was the influencing factor of renal insufficiency in the patients with DKD(P< 0.05), while CRP and ALB were not the influencing factors of renal insufficiency in the patients with DKD.Conclusion The predictive value of CAR≥0.37 for renal insufficiency in patients with DKD is higher than that of CRP and ALB, and CAR≥0.37 may be an independent influencing factor of renal insufficiency.
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表 1 3种检测指标AUC比较
检测方法 面积差异 Se z P CRP vs ALB 0.003 0.072 0.214 0.637 CRP vs CAR 0.059 0.045 1.947 0.036 ALB vs CAR 0.062 0.055 2.012 0.029 
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表 2 不同CAR组间临床资料比较
X±S 临床资料 CAR≥0.37(43例) CAR < 0.37(54例) t/χ2 P 性别/例 0.446 0.504 男 26 29 女 17 25 年龄/岁 61.14±7.23 61.11±9.00 0.017 0.987 病程/年 9.23±2.31 8.07±2.71 2.231 0.028 SBP/mmHg 141.91±11.06 143.07±9.68 0.554 0.581 DBP/mmHg 84.53±8.71 85.39±5.89 0.575 0.567 e-GFR/(mL·min-1·1.73 m-2) 47.24±12.93 64.86±12.37 6.832 < 0.001 是否肾功能不全/例 22.311 < 0.001 是 35 18 否 8 36 UA/(mmol·L-1) 367.02±26.08 354.85±32.26 2.006 0.048 CRP/(mg·L-1) 17.56±2.56 12.18±2.53 10.307 < 0.001 ALB/(g·L-1) 36.09±5.51 42.31±5.17 5.713 < 0.001 CAR/(mg·L-1) 0.494±0.09 0.289±0.05 14.172 < 0.001 HbA1c/% 7.21±0.45 7.16±0.43 0.614 0.541 FPG/(mmol·L-1) 8.45±1.08 7.95±1.19 2.142 0.035 Hb/(g·L-1) 110.14±9.90 114.94±7.97 2.648 0.009 NLR 2.47±0.45 2.15±0.24 4.468 < 0.001 WBC/(×109·L-1) 6.40±0.99 5.98±1.05 2.040 0.044
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表 3 DKD肾功能不全单因素分析
X±S 临床资料 肾功能不全组(53例) 非肾功能不全组(44例) t/χ2 P 性别/例 0.713 0.378 男 28 27 女 25 17 年龄/岁 60.17±8.32 61.91±8.13 0.856 0.394 病程/年 9.58±1.98 7.38±2.75 4.567 < 0.001 SBP/mmHg 144.17±11.35 140.61±8.53 1.713 0.090 DBP/mmHg 84.55±7.98 85.57±6.30 0.689 0.493 e-GFR/(mL·min-1·1.73 m-2) 45.44±9.48 71.03±7.08 14.809 < 0.001 UA/(mmol·L-1) 366.98±27.19 352.14±31.82 2.477 0.015 CRP/(mg·L-1) 15.89±3.60 12.97±3.16 4.208 < 0.001 ALB/(g·L-1) 37.60±5.72 41.91±5.85 3.650 < 0.001 CAR/(mg·L-1) 0.44±0.13 0.31±0.08 5.499 < 0.001 CAR≥0.37/例 22.311 < 0.001 是 35 8 否 18 36 HbA1c/% 7.24±0.51 7.13±0.39 1.174 0.244 FPG/(mmol·L-1) 8.37±1.12 8.03±1.16 1.465 0.146 Hb/(g·L-1) 110.56±9.19 115.53±8.44 2.744 0.006 NLR 2.44±0.43 2.13±0.23 4.223 < 0.001 WBC/(×109·L-1) 6.10±0.97 6.25±1.13 0.719 0.474
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表 4 DKD患者肾功能不全多因素分析
变量 P OR 95%CI 下限 上限 CAR≥0.37 0.006 3.845 1.570 8.946 病程 0.003 1.420 1.128 1.788 NRL < 0.001 4.605 1.838 9.681 Hb 0.333 0.969 0.909 1.033
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表 5 纠正混采因素不同指标对肾功能不全的影响
变量 P OR 95%CI 下限 上限 CAR≥0.37 0.006 3.845 1.570 8.946 CRP 0.140 1.135 0.959 1.342 ALB 0.054 0.913 0.832 1.001
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