血清C-反应蛋白和D-二聚体水平对危重症肺结核患者预后的预测价值

doi:10.19983/j.issn.2096-8493.20260034

结核与肺部疾病杂志 ›› 2026, Vol. 7 ›› Issue (4): 448-453.doi: 10.19983/j.issn.2096-8493.20260034

血清C-反应蛋白和D-二聚体水平对危重症肺结核患者预后的预测价值

魏云霞¹^,², 王鑫¹^,²(), 龙雪娟²^,³, 李宁²^,⁴, 桑珍珍⁵

¹ 河北省胸科医院肺病重点实验室, 石家庄 050047
² 河北省肺病重点实验室, 石家庄 050047
³ 河北省胸科医院急诊科, 石家庄 050047
⁴ 河北省胸科医院重症医学科, 石家庄 050047
⁵ 河北省沧州市中心医院急诊科, 沧州061012

收稿日期:2026-03-02 出版日期:2026-08-20 发布日期:2026-08-10
通信作者: 王鑫 E-mail:wangxinxkyy@163.com
基金资助:
河北省医学科学研究课题计划资助项目(20231215);政府资助临床医学优秀人才培养项目

The predictive value of serum C-reactive protein and D-dimer levels for the prognosis of patients with severe pulmonary tuberculosis

Wei Yunxia¹^,², Wang Xin¹^,²(), Long Xuejuan²^,³, Li Ning²^,⁴, Sang Zhenzhen⁵

¹ Key Laboratory of Pulmonary Disease, Hebei Chest Hospital, Shijiazhuang 050047, China
² Hebei Provincial Key Laboratory of Pulmonary Disease, Shijiazhuang 050047, China
³ Department of Emergency, Hebei Chest Hospital, Shijiazhuang 050047, China
⁴ Department of Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang 050047, China
⁵ Department of Emergency, Cangzhou Central Hospital, Hebei Province, Cangzhou 061012, China

Received:2026-03-02 Online:2026-08-20 Published:2026-08-10
Contact: Wang Xin E-mail:wangxinxkyy@163.com
Supported by:
Fund program Medical Science Research Project of Hebei Province(20231215);Government-funded Project for the Cultivation of Outstanding Clinical Medical Talents

摘要/Abstract

摘要：

目的: 评估血清C-反应蛋白(C-reactive protein, CRP)、纤维蛋白D-二聚体(简称“D-二聚体”)对入住重症监护病房(intensive care units, ICU)肺结核患者预后的应用价值。方法: 采用回顾性研究方法,参照入组标准从病例信息系统中收集2022年4月至2024年4月河北省胸科医院ICU收治的102例肺结核患者的相关病史资料及入住ICU 24h的检验结果,依据患者入住ICU 28d是否生存分为生存组与死亡组。采用二元logistic回归模型分析入住ICU肺结核患者28d预后的相关影响因素,并绘制受试者工作特征(ROC)曲线评估血清CRP、D-二聚体水平对入住ICU的肺结核患者预后的预测价值。结果: 入住ICU肺结核患者28d内生存组有60例(58.8%),死亡组有42例(41.2%)。多因素logistic回归分析结果显示,血清CRP和D-二聚体水平及急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APAHCE Ⅱ)升高均是入住ICU肺结核患者28d内死亡的独立预警因素[OR(95%CI)值分别为1.017(1.003~1.030)、1.318(1.041~1.669)、1.706(1.170~2.489)]。ROC曲线分析结果显示,血清CRP和D-二聚体单独预测入住ICU肺结核患者28d内死亡风险的AUC分别为0.765(95%CI:0.670~0.861)和0.775(0.681~0.870),临界值分别为87.845mg/L和4.375μg/ml;二者联合检测的预测AUC最高,为0.833(95%CI:0.752~0.914)。结论: 血清CRP及D-二聚体水平均对危重症肺结核患者预后有一定预测价值,二者联合检测的预测效能更高。

关键词: 结核,肺, 危重病, C反应蛋白质, 纤维蛋白, 预后

Abstract:

Objective: To explore the application value of serum C-reactive protein (CRP) and D-dimer in predicting the prognosis of pulmonary tuberculosis patients in the intensive care unit (ICU). Methods: Using a retrospective study methodology, relevant medical history records and 24-hour ICU admission test results of 102 pulmonary tuberculosis patients admitted to the ICU of Hebei Provincial Chest Hospital from April 2022 to April 2024 were collected from the case information system according to the inclusion criteria. According to the survival status of the enrolled patients within 28 days after admission to ICU, they were divided into the survival group (survived within 28 days) and the death group (died within 28 days). A binary logistic regression model analysis was used to analyze the related factors influencing the 28-day prognosis of ICU patients with pulmonary tuberculosis, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum CRP and D-dimer levels for the prognosis of pulmonary tuberculosis patients in the ICU. Results: Among the patients with pulmonary tuberculosis admitted to the ICU, 60 cases (58.8%) survived within 28 days, while 42 cases (41.2%) died. Multivariate logistic regression analysis showed that the levels of serum CRP and D-dimer, as well as an increased acute physiology and chronic health evaluation Ⅱ (APAHCE Ⅱ) score, were independent predictors for death within 28 days in ICU patients with pulmonary tuberculosis, with OR values of 1.017 (95%CI:1.003-1.030), 1.318 (95%CI:1.041-1.669) and 1.706 (95%CI:1.170-2.489), respectively. The ROC curve analysis results showed that the area under the curve (AUC) of serum CRP and D-dimer alone for predicting the risk of death within 28 days in ICU patients with pulmonary tuberculosis were 0.765 (95%CI:0.670-0.861) and 0.775 (95%CI:0.681-0.870), with cutoff values of 87.845 mg/L and 4.375 μg/ml, respectively; the combined detection of both serum CRP and D-dimer had the highest AUC of 0.833 (95%CI:0.752-0.914) for predicting the risk of death. Conclusion: The levels of serum CRP and D-dimer have certain predictive value for the prognosis of pulmonary tuberculosis patients in the ICU, and the combined detection of the two has a higher predictive efficacy.

Key words: Tuberculosis, pulmonary, Critical illness, C-reactive protein, Fibrin, Prognosis

中图分类号:

R521

魏云霞, 王鑫, 龙雪娟, 李宁, 桑珍珍. 血清C-反应蛋白和D-二聚体水平对危重症肺结核患者预后的预测价值[J]. 结核与肺部疾病杂志, 2026, 7(4): 448-453. doi: 10.19983/j.issn.2096-8493.20260034

Wei Yunxia, Wang Xin, Long Xuejuan, Li Ning, Sang Zhenzhen. The predictive value of serum C-reactive protein and D-dimer levels for the prognosis of patients with severe pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(4): 448-453. doi: 10.19983/j.issn.2096-8493.20260034

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变量	合计(102例)	生存组(60例)	死亡组(42例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	64.00(58.00,71.25)	63.00(58.00,70.25)	64.00(60.00,72.50)	Z=-0.885	0.376
性别[例(构成比,%)]				χ²=0.797	0.372
男性	78(76.5)	44(73.3)	34(81.0)
女性	24(23.5)	16(26.7)	8(19.0)
BMI(kg/m²,$\overline{\mathit{x}}$±s)	23.08±4.05	23.50±4.39	22.48±3.46	t=1.256	0.212
MAP(mmHg,$\overline{\mathit{x}}$±s)	83.47±13.69	85.63±13.60	80.38±13.34	t=1.933	0.056
HR[次/min,M(Q₁,Q₃)]	94.00(88.00,107.25)	92.50(82.50,102.75)	96.50(89.00,111.75)	Z=-1.990	0.047
OI[mmHg,M(Q₁,Q₃)]	162.15(132.17,186.25)	167.50(145.33,193.15)	147.90(118.15,176.25)	Z=-3.295	0.001
D-二聚体[μg/ml,M(Q₁,Q₃)]	3.87(1.48,6.74)	2.72(1.09,4.24)	6.05(2.98,13.63)	Z=-4.719	<0.001
CRP[mg/L,M(Q₁,Q₃)]	95.54(34.55,170.37)	57.56(21.98,113.13)	147.39(86.84,209.85)	Z=-4.549	<0.001
APACHE Ⅱ(分,$\overline{\mathit{x}}$±s)	29.00(23.75,34.00)	24.93±4.67	35.38±5.35	t=-10.479	<0.001
SOFA[分,M(Q₁,Q₃)]	9.00(7.00,12.00)	7.50(6.00,9.00)	12.00(10.75,14.00)	Z=-7.073	<0.001

变量	β值	s${}_{\overline{\mathit{x}}}$值	Wald χ²值	P值	OR值	95%CI值
HR	-0.017	0.027	0.399	0.528	0.983	0.931~1.037
OI	-0.017	0.016	1.211	0.271	0.983	0.953~1.014
D-二聚体	0.276	0.120	5.252	0.022	1.318	1.041~1.669
CRP	0.016	0.007	5.810	0.016	1.017	1.003~1.030
APACHE Ⅱ	0.534	0.193	7.704	0.006	1.706	1.170~2.489
SOFA	0.361	0.200	3.254	0.071	1.435	0.969~2.126
常量	-18.725	6.218	9.068	0.003	-	-

变量	临界值	约登指数	敏感度(%)	特异度(%)	AUC值	95%CI值	P值
CRP	87.845mg/L	0.462	76.2	70.0	0.765	0.670~0.861	<0.001
D-二聚体	4.375μg/ml	0.505	73.8	76.7	0.775	0.681~0.870	<0.001
二者联合	-	0.529	76.2	76.7	0.833	0.752~0.914	<0.001

血清C-反应蛋白和D-二聚体水平对危重症肺结核患者预后的预测价值

The predictive value of serum C-reactive protein and D-dimer levels for the prognosis of patients with severe pulmonary tuberculosis

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