CRP/HDL在纤维化间质性肺疾病中的预后 价值

Prognostic Value of the CRP/HDL Ratio in Fibrotic Interstitial Lung Disease

摘要: 目的：探讨C-反应蛋白与高密度脂蛋白比值(CRP/HDL)对纤维化型间质性肺疾病(F-ILD)患者不良预后的预测价值。方法：回顾性分析141例F-ILD患者的临床资料。收集患者基线一般资料、血脂谱、CRP、肺功能指标(FVC%pred, DLCO%pred)及HRCT纤维化视觉评分。采用接收者操作特征(ROC)曲线评估各指标的预测效能，并通过DeLong检验比较AUC的差异。根据最佳截断值将患者分为高CRP/HDL组与低CRP/HDL组，利用Kaplan-Meier法绘制生存曲线并进行Log-rank检验。采用逐步校正的Cox比例风险回归模型评估CRP/HDL与预后的独立相关性。结果：ROC曲线显示CRP/HDL预测不良预后的AUC为0.678，显著优于单纯CRP (AUC: 0.604, P = 0.002)，且高于FVC%pred (AUC: 0.647)。Kaplan-Meier生存分析显示，高CRP/HDL组的累积生存率显著低于低CRP/HDL组(Log-rank P < 0.0001)。在校正了年龄以及FVC%pred的多因素Cox模型中，CRP/HDL升高是不良预后的独立危险因素(HR = 1.18, 95% CI: 1.03~1.39, P = 0.029)；但在进一步纳入HRCT评分后，其显著性有所下降(P = 0.108)。结论：CRP/HDL比值是F-ILD患者不良预后的简便且有效的预测指标。尽管其预测效能与HRCT评分存在一定的重叠，但作为一种无创、易得的生物标志物，CRP/HDL在F-ILD患者的早期风险分层中具有重要的临床应用价值。

Abstract: Objective: To investigate the prognostic value of the C-reactive protein to high-density lipoprotein ratio (CRP/HDL) in patients with fibrotic interstitial lung disease (F-ILD). Methods: A retrospective analysis was conducted on the clinical data of 141 patients with F-ILD. Baseline demographic characteristics, lipid profiles, CRP levels, pulmonary function parameters (FVC%pred, DLCO%pred), and HRCT fibrosis visual scores were collected. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive performance of each indicator, and the DeLong test was used to compare differences in the area under the curve (AUC). Patients were stratified into high and low CRP/HDL groups based on the optimal cut-off value. Survival curves were generated using the Kaplan-Meier method and compared via the Log-rank test. Stepwise adjusted Cox proportional hazards regression models were utilized to assess the independent association between CRP/HDL and prognosis. Results: ROC curve analysis revealed that the AUC of CRP/HDL for predicting adverse outcomes was 0.678, which was significantly superior to CRP alone (AUC: 0.604, P = 0.002) and higher than that of FVC%pred (AUC: 0.647). Kaplan-Meier survival analysis demonstrated that the cumulative survival rate in the high CRP/HDL group was significantly lower than that in the low CRP/HDL group (Log-rank P < 0.0001). In the multivariate Cox model adjusted for age and FVC%pred, elevated CRP/HDL was identified as an independent risk factor for adverse prognosis (HR = 1.18, 95% CI: 1.03~1.39, P = 0.029); however, its significance decreased after further inclusion of HRCT scores (P = 0.108). Conclusion: The CRP/HDL ratio serves as a simple and effective predictor of adverse prognosis in patients with F-ILD. Although its predictive performance overlaps to some extent with HRCT scores, as a non-invasive and readily accessible biomarker, CRP/HDL holds significant clinical value for early risk stratification in F-ILD patients.