| BACKGROUND: Ulcerative colitis(UC)is an idiopathic,chronic inflammatory disease of the colonic mucosa that often begins in the rectum and progresses proximally to part or the entire colon in an inverted fashion.Endoscopy is the gold standard for assessing the severity of UC disease,but it is an invasive test and requires bowel preparation,patient compliance is poor,and it should not be performed frequently.Serum biomarkers are often used as a non-invasive means to clarify disease activity,are simple and easy to perform,and have important value in the clinical application of UC,which has become a research hotspot in recent years.OBJECTIVE: To analyze the correlation between serum albumin,inflammatory indexes and coagulation function with three aspects of disease clinical activity,endoscopic mucosal inflammatory activity and extent of lesion involvement in patients with UC,and to explore their role and that of C-reactive protein to serum albumin ratio(CAR)in assessing the severity of UC disease.METHODS: Ninety-two UC patients hospitalized in the Second Hospital of Dalian Medical University from June 2020 to May 2022 were used as the study population.Serum albumin(Alb),inflammatory indexes(CRP,ESR,TNF-α,IL2 R,IL6,IL8),coagulation indexes(platelets,D-dimer,fibrinogen),and C-reactive protein to serum albumin ratio(CAR)were retrospectively analyzed in patients with UC in relation to clinical activity of disease,endoscopic mucosal inflammatory activity(Mayo score,ulcerative colitis endoscopic severity index score UCEIS score),and the extent of lesion involvement,and to further explore the significance of CAR in the clinical activity of UC disease and endoscopic Mayo score.Finally,logistic regression was used to analyze the risk factors associated with the endoscopic inflammatory activity of UC.Results:1,General data analysis: there was no significant difference in the gender composition,age,and BMI comparison between active and remitting UC patients(p>0.05).2,Correlation analysis of various serum indicators and clinical disease activity of UC.2.1 Alb(r=-0.448,p<0.001)in UC patients showed a significant negative correlation with UC clinical activity.2.2 Inflammatory indexes: CRP(r=0.583,p<0.001),ESR(r=0.438,p<0.01),IL-2R(r=0.451,p<0.001),IL-6(r=0.540,p<0.001),and TNF-α(r=0.255,p<0.05)were significantly and positively correlated with the clinical activity of UC.IL-8(r=0.157,p>0.05)had no significant correlation with the clinical activity of UC.2.3 Coagulation indexes: platelets(r=0.493,p<0.001),D-dimer(r=0.460,p<0.001)and fibrinogen(r=0.604,p<0.001)showed significant positive correlation with the clinical activity of UC.3.Correlation analysis of each serum index and endoscopic inflammatory activity of UC.3.1 Correlation analysis of each serum index with UC endoscopic Mayo score.3.1.1 Alb(r=-0.430,p<0.001)in UC patients was significantly negatively correlated with endoscopic Mayo score.3.1.2 Inflammatory indexes: CRP(r=0.476,p<0.001),ESR(r=0.390,p<0.001),IL-2R(r=0.371,p<0.001),IL-6(r=0.444,p<0.001),TNF-α(r=0.297,p<0.01)were significantly positive correlation.il-8(r=0.139,p>0.05)was not significantly correlated with endoscopic Mayo score.3.1.3 Coagulation indexes: platelets(r=0.364,p<0.001),D-dimer(r=0.347,p<0.01)and fibrinogen(r=0.550,p<0.001)showed significant positive correlation with endoscopic Mayo score.3.2 Correlation analysis of various serum indicators with endoscopic UCEIS scores in UC.3.2.1 Alb in UC patients(r=-0.546,p<0.001)was significantly negatively correlated with UCEIS score.3.2.2 Inflammatory indicators: CRP(r=0.612,p<0.001),ESR(r=0.485,p<0.001),IL-2R(r=0.458,p<0.001),IL-6(r=0.531,p<0.001),IL-8(r=0.178,p<0.001),TNF-α(r= 0.291,p<0.01)were significantly and positively correlated with UCEIS scores.3.2.3 Coagulation indexes: platelets(r=0.421,p<0.001),D-dimer(r=0.483,p<0.001),and fibrinogen(r=0.670,p<0.001)were significantly and positively correlated with the UCEIS score.3.3 Correlation analysis of various serum indicators with the extent of UC lesions.3.3.1 Alb(r=-0.373,p<0.001)in UC patients was significantly negatively correlated with the extent of endoscopic involvement.3.3.2 Inflammatory indexes: CRP(r=0.383,p<0.001),ESR(r=0.350,p<0.01),IL-2R(r=0.438,p<0.001),IL-6(r=0.367,p<0.001),and TNF-α(r=0.368,p<0.01)were significantly and positively correlated with the extent of endoscopic involvement.However,IL-8(r=0.139,p>0.05)was not significantly correlated with the extent of UC endoscopic involvement.3.3.3 Coagulation indicators: platelets(r=0.403,p<0.001),D-dimer(r=0.372,p<0.001)and fibrinogen(r=0.353,p<0.01)showed significant positive correlation with the extent of endoscopic involvement.4.Analysis of correlation between CAR values and disease activity of UC.4.1 CAR values were significantly and positively correlated with clinical activity of UC(r=0.604,p<0.001),endoscopic Mayo score(r=0.511,p<0.001),UCEIS score(r=0.640,p<0.001),and extent of endoscopic involvement(r=0.385,p<0.001).4.2 The difference in CAR values between patients with mild to moderate UC compared to severe was statistically significant(p<0.001).ROC curve analysis showed that CAR had better diagnostic accuracy for differentiating mild to moderate from severe with an AUC of 0.847,a critical value of 0.228,sensitivity of 74.4% and specificity of 95.2%(p<0.01).CAR had better diagnostic accuracy for differentiating Mayo score 0-2 score and 3 had better diagnostic accuracy with an AUC of 0.796,a critical value of 0.228,a sensitivity of 59.2% and a specificity of 95.3%.(p<0.01).5.Analysis of various serum indicators and risk factors of endoscopic Mayo score in UC patients: Alb,CRP,ESR,IL2 R,IL6,platelets,fibrinogen,and D-dimer as risk factors for Mayo score,among which serum fibrinogen level was an independent risk factor of Mayo score in ulcerative colitis,and the higher its level,the higher the Mayo score.Conclusion:1,serum albumin level in patients with ulcerative colitis was significantly negatively correlated with the severity of UC disease,and the inflammatory indexes and coagulation indexes of CRP,ESR,IL-2R,IL-6,TNFα,platelets,D-dimer,and fibrinogen water mean were significantly and positively correlated with the severity of UC disease,and these indexes can be used as important reference indexes to assess the severity of UC disease,and These indicators have good reproducibility and have high clinical application value.The C-reactive protein to serum albumin ratio CAR was significantly higher in patients with severe clinical activity and endoscopic Mayo score of 3 than in other patients,and the specificity and sensitivity of the CAR value in differentiating patients with severe disease showed that the CAR value has clinical significance in assessing the severe inflammatory activity of UC patients with clinical and endoscopic disease.3,Multifactorial analysis showed that fibrinogen level was an independent risk factor affecting endoscopic Mayo score in patients with UC.It indicates that the higher the fibrinogen level,the higher the Mayo score and the higher the endoscopic severity,which can be used as a reference to assess the endoscopic disease activity. |
