重症患者基础尿酸水平与感染预后关系  

Rlationship between serum levels of uric acid and prognosis of infection in the critically ill

作　　者：叶若兰[1] 曹隽[1] 祝禾辰[1] 

机构地区：[1]复旦大学附属华山医院危重病科,上海200040

出　　处：《中华急诊医学杂志》2012年第4期351-355,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨重症监护室（ICU）感染患者中基础血清尿酸水平的分布及其与预后的关系。方法回顾性收集2003年1月至2010年4月收住华山医院中心ICU且存在感染的患者共471例。入选标准：入院时或住院过程中明确诊断有单、多部位感染的患者。记录患者入院24h血清尿酸、肌酐、尿素氮测量值及其他临床资料，描述尿酸的分布，并以t检验等分析评估尿酸与基础疾病的相关性。对不同尿酸水平病例进行分组，运用X2检验比较其预后等特征差异。P〈0．05为差异有统计学意义。结果（1）入院24h内的尿酸值为（0．232±0.131）mmol／L（中位数0，199mmol／L）。（2）尿酸值在以下基础疾病中的分布有显著变化：高血压（t=-3．084，P=0．002）、糖尿病（t=-2．487，P=0．013）、脑梗死（t=-3．061，P=0．002）、。肾功能不全（t=-4．547，P〈0．01）、中枢神经系统感染（t=5．096，P〈0．01）和外伤（t=2．875，P=0．004）。（3）血尿酸与肌酐和尿素氮均有直线相关性（P〈0．01，F值分别为159．470，165．059）。（5）基础尿酸水平与感染患者预后之间无统计学意义x2=60．892，P：0．100）。结论本研究发现基础尿酸水平与ICU患者感染的预后没有直接相关性。Objective To explore the clinical implications of the initial levels of serum uric acid （SUA） after admission in the critically ill patients with infection, and to investigate the relationship between SUA and prognosis of infection. Methods From January 2003 to April 2010, 471 patients with infection were admitted to the ICU of Huashan Hospital, Fudan University, Shanghai. Data, including serum uric acid （SUA） , serum creatinine, blood urea nitrogen （BUN） and other relevant laborartory results within 24 hours after admission, were retrospectively analyzed. The distribution of uric acid was described. The t test was used to evaluate the relation between SUA and preexisting disorders. Patients with different level of SUA were classfied for further analysis. X2 test was used to examine the difference in the prognosis of infection. Results The mean initial level of SUA within 24 hours after admission was 0. 232 ＋ 0. 131 mmol/L and the median 0. 199 mmoL/L. Remarkable difference in initial levels of SUA were observed in patients with preexisting hypertension （t = -3. 084, P=0. 002）, diabetes mellitus （t = -2.487, P=0. 013）, cerebral infarction （ t = - 3.061, P = 0. 002）, renal insufficiency （t = - 4. 547, P 〈 0. 01 ）, central nervous system infection （t = 5. 096, P 〈 0.01 ） and trauma （ t = 2. 875, P = 0. 004 ）. Serum uric acid was linearly correlated with serum creatinine and blood urea nitrogen （F = 159. 470 and 165. 059, respectively; P 〈 0. 01 ）. No statistical correlation was found between initial levels of SUA and prognosis of infection （ X2 =60. 892, P=-0. 100）. Conclusions There is no direct correlation between the initial levels of SUA after admission and the prognosis of infection in the critically ill patients.

关 键 词：重症监护室 感染 尿酸 尿素氮 肌酐 肺炎 中枢神经系统感染 肾功能不 全 预后 

分 类 号：R459.7[医药卫生—急诊医学]