摘要
目的探讨C反应蛋白/白蛋白(C-reactive protein/albumin,CRP/ALB)、降钙素原(procaicltonin,PCT)/ALB与急性创伤后应激障碍(post-traumatic stress disorder,PTSD)发病的相关性。方法选取2019-07/2021-07月因急性创伤送至作者医院治疗的196例患者作为研究对象。采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测患者入院后血清CRP、ALB、PCT水平,并计算CRP/ALB、PCT/ALB。1个月后采用第五版创伤后应激障碍测评量表(PTSD checklist for DSM-5,PCL-5)评估患者PTSD症状,并根据评分结果分为PTSD组(PCL-5≥38分,86例)和非PTSD组(PCL-5<38分,110例)。比较两组临床一般资料以及血清CRP、ALB、PCT、CRP/ALB、PCT/ALB的差异。同时采用Pearson相关分析探讨血清CRP/ALB、PCT/ALB与PCL-5、心理韧性量表(Connor-Davidson resilience scale,CD-RISC)评分的相关性。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估CRP/ALB、PCT/ALB对急性PTSD发病的诊断价值。采用多因素Logistic回归分析探讨影响急性创伤患者PTSD发病的相关因素。结果PTSD组急性创伤患者CD-RISC评分明显低于非PTSD组(P<0.05),女性比例、PCL-5评分明显高于非PTSD组(P<0.05)。PTSD组急性创伤患者血清CRP、PCT、CRP/ALB、PCT/ALB水平均明显高于非PTSD组(P<0.05),血清ALB水平明显低于非PTSD组(P<0.05)。Pearson相关性分析结果显示,急性创伤患者血清CRP/ALB、PCT/ALB与PCL-5评分均呈正相关(P<0.05),与CD-RISC评分均呈负相关(P<0.05)。ROC曲线分析结果显示,CRP/ALB诊断急性创伤患者PTSD曲线下面积(area under the curve,AUC)、敏感度、特异度分别为0.820、85.3%、88.3%;PCT/ALB AUC、敏感度、特异度分别为0.803、82.6%、90.1%。多因素Logistic回归分析结果显示,血清CRP/ALB≥1.25、PCT/ALB≥0.95及女性、CD-RISC评分<24分均是影响急性创伤患者PTSD发病的危险因素(P<0.05)。结论急性创伤后PTSD患者血清CRP/ALB、PCT/ALB水平均明显升高,且其水平变化与PTSD症状呈正相关,与心理韧性呈负相关,有望作为临床早期预测、早期诊断急性PTSD发病的辅助生物标志物。
Objective To investigate the correlation between C-reactive protein/albumin(CRP/ALB),procalcitonin(PCT)/ALB and acute post-traumatic stress disorder(PTSD).Methods A total of 196 cases who were sent to the emergency department in author′s hospital for treatment due to acute trauma from July 2019 to July 2021 were selected as the research objects.Serum CRP,ALB and PCT levels after admission were detected by enzyme-linked immunosorbent assay(ELISA),and CRP/ALB and PCT/ALB were calculated.One month later,the PTSD symptoms of patients were assessed by PTSD checklist for DSM-5(PCL-5),and the patients were divided into PTSD group(PCL-5≥38 score,n=86)and non-PTSD group(PCL-5<38 score,n=110).The general clinical data of the two groups and differences in serum CRP,ALB,PCT,CRP/ALB,PCT/ALB were compared,and correlation between serum CRP/ALB,PCT/ALB and PCL-5,Connor-Davidson resilience scale(CD-RISC)score were explored by Pearson correlation analysis.The diagnostic value of CRP/ALB and PCT/ALB for the onset of acute PTSD was evaluated by receiver operating characteristic(ROC)curve,and the relevant factors affecting the onset of PTSD in patients with acute trauma were investigated by multivariate Logistic regression analysis.Results The CD-RISC score of acute trauma patients in the PTSD group was lower than that of the non-PTSD group(P<0.05),and the proportion of female and the PCL-5 score were higher than those of the non-PTSD group(P<0.05).The serum CRP,PCT,CRP/ALB,PCT/ALB levels of acute trauma patients in the PTSD group were higher than those of the non-PTSD group(P<0.05),and the serum ALB levels were lower than those of the non-PTSD group(P<0.05).Pearson correlation analysis showed that the serum CRP/ALB,PCT/ALB were positively correlated with PCL-5 score of acute trauma patients(P<0.05),and were negatively correlated with CD-RISC scores(P<0.05).ROC curve showed that the area under the curve(AUC),sensitivity and specificity of CRP/ALB in the diagnosis of acute trauma PTSD patients were 0.820,85.3%and 88.3%respectively;PCT/ALB AUC,sensitivity and specificity were 0.803,82.6%and 90.1%respectively.Multivariate Logistic regression analysis showed that serum CRP/ALB≥1.25,PCT/ALB≥0.95,female and CD-RISC score<24 were all risk factors which affecting the onset of PTSD in acute trauma patients(P<0.05).Conclusion Serum CRP/ALB and PCT/ALB levels in PTSD patients after acute trauma are significantly increased,and their level changes are positively correlated with PTSD symptoms and negatively correlated with mental resilience.These index are expected to be used as auxiliary biomarkers for early clinical prediction and early diagnosis of acute PTSD.
作者
洪国耀
汪步春
罗靖
HONG Guoyao;WANG Buchun;LUO Jing(Department of Emergency,NO.922 Hospital of Joint Logistics Support Force of People′s Liberation Army,Hengyang Hunan 421002,China)
出处
《华南国防医学杂志》
CAS
2022年第5期355-358,382,共5页
Military Medical Journal of South China
关键词
C反应蛋白
白蛋白
降钙素原
急性创伤
创伤后应激障碍
C-reactive protein
Albumin
Procalcitonin
Acute trauma
Post-traumatic stress disorder
