即时生物电阻抗分析参数与危重症患者预后的关系  

Bioimpedance analysis as markers to predict prognosis in critically ill patients

作　　者：姚佳舒 周敏林 徐斌 李川 陈海燕 龚德华 YAO Jiashu;ZHOU Minlin;XU Bin;LI Chuan;CHEN Haiyan;GONG Dehua(National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210016, China)

机构地区：[1]南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心全军肾脏病研究所,硕士研究生南京210016

出　　处：《肾脏病与透析肾移植杂志》2018年第3期214-219,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金面上项目(81470992); 国家重点研发项目(2017YFC1104400)

摘　　要：目的:通过前瞻性观察危重病患者生物阻抗分析(BIA)参数与临床预后之间的关联,探讨BIA在预测预后方面的价值。方法:选择2017年6月至12月南京总医院重症监护室(ICU)自愿参加的患者。入选后即使用QuadScan 4000 BIA设备测量患者多频生物电阻抗,并采用急性生理学和慢性健康评估Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)及序贯器官衰竭评估(SOFA)对患者进行评分。记录患者临床资料及预后。分析临床预后与BIA参数之间的关系。结果:入选201例患者,90d死亡率35.8%。患者电阻抗值(Z)与电流频率(f)的关系与指数函数拟合度高,并得到回归系数(S值)。BIA得到参数还包括相位角(PA),阻抗比(IR,200 kHz/5kHz的电阻抗比值)、细胞外水(ECW)、细胞内水(ICW)及总体水(TBW)等。7d死亡患者ECW/体重、ECW/TBW、阻抗比(IR)、S值、PA与存活组有显著差异(P<0.05);90d死亡患者ECW/体重、IR、S值、PA与存活组有显著差异(P<0.05)。多因素Logistic回归分析显示,除SAPSⅡ外,S值是7d及90d唯一的死亡独立危险因素(P<0.01)。预测7d及90d死亡的受试者工作特性曲线下面积(AUC)值中SAPSⅡ最高;而BIA参数中S值AUC值最高,两者无显著差异(P>0.05)。S值≤-25.5时患者7d、90d死亡率均为0,大于此值者死亡率随着S值增加而线性升高;而SAPSⅡ≤33的患者死亡率变化很小,分值33～55时随分值增加而线性升高,分值>55时死亡率为100%。结论:S值和SAPSⅡ是预测危重患者7d及90d死亡的独立危险因素:两者预测7d及90d死亡的精确度无差异,前者预测存活患者预测价值更高,而后者预测死亡患者预测价值更高。BIA可用于评估重症患者的疾病严重程度及预后判断。Objective： To explore the value of bioimpedance analysis（ BIA） in assessment of predicting prognosis. Methodology： Two hundred and one patients in the intensive care units of our hospital were voluntarily enrolled.They were assessed using a device Quad Scan 4000 for measurement of BIA,as well as by Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ）,Simplified Acute Physiology Score Ⅱ（ SAPS Ⅱ） and Sequential Organ Failure Assessment（ SOFA）. The association between clinical conditions,outcomes and BIA parameters were analyzed.Results：Among 201 enrolled patients,the 90-day mortality was 35. 8%.The relationship of individual bioimpedance values and the current frequencies was in good fitting of nature lograrithmic function,with a regression coefficient S value. Other parameters obtained from BIA included phase angle（ PA）,ratio of bioimpedance in high frequency and in low frequency（IR）,and extracellular water（ECW）,intracellular water（ICW） and total body water（TBW）.Compared to the survivors in 7-day,the IR,S value,ratio of ECW/weight,and ratio of ECW/TBW were higher while the PA were lower in the dead（P〈0. 05）.Compared to the survivors in 90-day,the IR,S value and ratio of ECW/weight were higher while the PA were lower in the dead（ P〈0. 05）. Multinomial logistic regression analysis showed that,only SAPS Ⅱ and S value were the independent risk factors for 7-day and 90-day death（ P〈0. 01）.Analyzed by ROC,the AUC of S value for predicting 90-day death was non-significantly lower than SAPS Ⅱ（ S vs. SAPS Ⅱ,0. 701 vs 0. 779,P〈0. 05）.Importantly,both the 7-day and the 90-day mortality in patients with S value ≤-25. 5 were 0,and for the others,the mortality was in linear correlation with S value; while for patients with SAPS Ⅱ≤33,the mortality remained little varied,for patients with SAPS Ⅱ 33 ～ 55,the mortality increased with the score of SAPS Ⅱ,and for patients with SAPS Ⅱ 55,the mortality was 100%. Conclusion：The S value

关 键 词：生物电阻抗 危重病 疾病严重程度 预后 

分 类 号：R459.7[医药卫生—急诊医学]