Objective  To investigate the correlation of C-reactive protein (CRP), albumin (ALB) and their ratio (CRP/ALB ratio, CAR) with the level of disease activity among patients with ulcerative colitis (UC). 

Methods  100 patients with UC admitted to Zhongnan Hospital of Wuhan University from March 2017 to May 2019 were recruited, along with 100 physically healthy controls matched for age and gen-der. The UC patients were divided into four groups: in remission, mild, moderate and severe active stage. The differences in CRP, ALB and CAR between the control group and the UC group were compared and their correlations analyzed using the modified Mayo score, their effectiveness in diagnosing UC was ana-lyzed using the ROC curve. 

Results  CRP and CAR in the UC group were significantly higher than those in healthy control group, and ALB were significantly lower than those in control group, with statistically significant dif-ferences (P< 0.05). Compared with UC patients in the disease remission stage and those with mild to moderate active stages, CAR in UC patients in the severe active stage were significantly higher, and the differences were statistically significant (P< 0.008).The modified Mayo score of UC patients was positively correlated with CRP and CAR (rCRP=0.546, rCAR=0.559), and negatively correlated with ALB (rALB=-0.448). The ability of the area under curve (AUC) of CRP, ALB, and CAR to distinguish UC disease activity from inactivity is 0.764, 0.726, 0.773, respectively. The sensitivity of CAR in diagnosing UC is 44.3%, and the specificity is 100%. The efficiency is better than CRP and ALB alone. 

Conclusion  CRP, ALB and CAR are significantly correlated with the modified Mayo score, and they can all predict UC disease ac-tivity. Among them, CAR has high predictive specificity and is expected to become a reliable index for assessing UC disease activity.

1.Ordás I, Eckmann L, Talamini M, et al. Ulcerative colitis[J]. Lancet, 2012, 380(9853): 1606-1619. DOI: 10.1016/S0140-6736(12)60150-0. 

2.姚萍, 陈玲, 孙健, 等. 外周血内PCT、CRP、ESR、PLT水平对炎症性肠病的预判价值分析[J]. 国际检验医学杂志, 2019, 40(22): 2762-2766. DOI: 10.3969/j.issn.1673-4130.2019.22.018. [Yao P, Chen L, Sun J, et al. Analysis of the predictive value of PCT, CRP, ESR and PLT levels in peripheral blood for inflammatory bowel dis-ease[J]. International Journal of Laboratory Medicine, 2019, 40(22): 2762-2766.] 

3.董月美, 张目涵, 张方, 等. NLR、MLR在溃疡性结肠炎中的临床意义[J]. 胃肠病学, 2019, 24(12): 729-733. DOI: 10.3969/j.issn.1008-7125.2019.12.005. [Dong YM, Zhang MH, Zhang F, et al . Clinical signifi-cance of NLR and MLR in ulcerative colitis[J]. Gastroenterology, 2019, 24(12): 729-733.]

4.Akpinar MY, Ozin YO, Kaplan M, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict mucosal disease severity in ulcerative colitis[J]. J Med Biochem, 2018, 37(2): 155-162. DOI: 10.1515/jomb-2017-0050.

5.Knyazev OV, Kagramanova AV, Korneeva IA, et al. The use of fecal calprotectin in monitoring activity of inflammatory bowel diseases[J]. Ter Arkh, 2019, 91(4): 53-61. DOI: 10.26442/00403660.2019.04.000229.

6.Tretyakova YI, Bulatova IA, Shchekotova AP, et al. Method of diagnosis of the severity of the disease attack in patients with ulcerative colitis[J]. Klin Lab Diagn, 2018, 63(7): 414-418. DOI: 10.18821/0869-2084-2018-63-7-414-418.

7.叶宗伟, 杨毅宁. 血清C反应蛋白、白蛋白及其比值在炎症相关性疾病中的进展[J]. 医学综述, 2017, 23(20): 3979-3983, 3988. DOI: 10.3969/j.issn.1006- 2084.2017.20.006. [Ye ZW, Yang YN. Current status and progress of serum c-reactive protein, albumin and its ratio in inflammatory related diseases[J]. Medi-cal Recapitulate, 2017, 23(20): 3979-3983, 3988.]

8.中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中华炎性肠病杂志, 2018, 2(3): 173-190. DOI: 10.3760/cma.j.issn.2096-367X.2018.03.005. [Inflammatory Bowel Disease Group, Chinese Society of Digestive Diseases. Consensus views on diagnosis and treatment of in-flam-matory bowel disease(Beijing.2018)[J]. Chinese Journal of Inflammatory Bowel Diseases, 2018, 2(3): 173-190.]

9.D'Haens G, Sandborn WJ, Feagan BG, et al. A review of activity indices and efficacy end points for clin-ical trials of medical therapy in adults with ulcerative colitis[J]. Gastroenterology, 2007, 132(2): 763-786. DOI: 10.1053/j.gastro.2006.12.038.

10.李珍艳, 李罗红, 李小琼, 等. ALB、CRP、PLT水平变化与克罗恩病患者黏膜愈合状态的关系研究[J]. 四川医学, 2019, 40(7): 690-693. DOI: 10.16252/j.cnki.issn1004-0501-2019.07.009. [Li ZY, Li LH, Li XQ et al. Study on the relationship between alb, crp and plt levels and the mucosal healing status of patients with crohn's disease[J]. Sichuan Medical Journal, 2019, 40(7): 690-693.] 

11.Krzystek-Korpacka M, Kempiński R, Bromke M, et al. Biochemical biomarkers of mucosal healing for inflammatory bowel disease in adults[J]. Diagnostics, 2020, 10(6): 367. DOI: 10.3390/diagnostics10060367.

12.刘丹, 周磊. 溃疡性结肠炎患者血小板、C反应蛋白、血沉的临床意义[J]. 中国现代药物应用, 2015, (18): 13-15. DOI: 10.14164/j.cnki.cn11-5581/r.2015.18.008. [Liu D, Zhou L. The clinical significance of platelet, C-reactive protein and erythrocyte sedimentation rate in patients with ulcerative colitis[J]. Chinese Journal of Modern Drug Application, 2015, (18): 13-15.]

13.Miranda-García P, Chaparro M, Gisbert JP. Correlation between serological biomarkers and endoscopic ac-tivity in patients with inflammatory bowel disease[J]. Gastroenterol Hepatol, 2016, 39(8): 508-515. DOI: 10.1016/j.gastrohep. 2016.01.015.

14.Khan N, Patel D, Shah Y, et al. Albumin as a prognostic marker for ulcerative colitis[J]. World J Gastroenterol, 2017, 23(45): 8008-8016. DOI: 10.3748/wjg.v23.i45.8008.

15.胡丽娟, 王瑜敏, 陈坚, 等. CRP/Alb比值在肺癌诊断和预后中的临床价值分析[J]. 医学研究杂志, 2018, 47(12): 27-30, 36. DOI: 10.11969/j.issn.1673-548X.2018.12.008. [Hu LJ, Wang YM, Chen J, et al. Clinical value of crp/alb ratio in diagnosis and prognosis of lung cancer[J]. Journal of Medical Research, 2018, 47(12): 27-30, 36.]

16.Yue L, Lu Y, Li Y, et al. Prognostic value of c- reactive protein to albumin ratio in gastric cancer: a me-ta-analysis[J]. Nutr Cancer, 2020, 1-8. DOI: 10.1080/01635581.2020.1817510.

17.Liu Z, Jin K, Guo M, et al. Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer[J]. Annals of Surgical Oncology, 2017, 24(2): 561-568. DOI: 10.1245/s10434-016-5579-3.

18.Sayar S, Kurbuz K, Kahraman R, et al. A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio[J]. North Clin Istanb, 2020, 7(1): 49-55. DOI: 10.14744/nci.2018.78800.

19.Choy M C, Seah D, Gorelik A, et al. Predicting response after infliximab salvage in acute severe ulcera-tive colitis[J]. J Gastroenterol Hepatol, 2018, 33(7): 1347-1352. DOI: 10.1111/jgh.14072.

20.Chen YH, Wang L, Feng SY, et al. The relationship between c-reactive protein/albumin ratio and dis-ease ac-tivity in patients with inflammatory bowel disease[J]. Gastroenterol Res Pract, 2020, 2020: 3467419. DOI: 10.11 55/2020/3467419.