系统性毛细血管渗漏综合征病程中血细胞比容与血浆白蛋白差值的变化：系统评价分析  

The difference between hematocrit and plasma albumin in the course of systemic capillary leak syndrome：a systematic review

作　　者：代冬梅[1] 唐坤[1] 许汪斌[1] 李梅[1] 苏瑜 王英[1] 胡锐 Dai Dongmei;Tang Kun;Xu Wangbin;Li Mei;Su Yu;Wang Ying;Hu Rui(Department of Intensive Care Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科, 云南昆明,650032

出　　处：《中华危重病急救医学》2018年第10期920-924,共5页Chinese Critical Care Medicine

基　　金：云南省科技计划项目重大科技专项（生物医药）项目（2018ZF009）

摘　　要：目的 探讨系统性毛细血管渗漏综合征（SCLS）病程中血细胞比容（Hct）与血浆白蛋白（Alb）的差值变化对患者的影响.方法 采用系统评价方法,从PubMed数据库中收集1996年1月1日至2015年9月30日发表的有关人类血管渗透的病案报道281篇,剔除与颅脑内血管渗漏和眼动静脉渗漏有关的文献,最后明确与SCLS有关的文献213篇（英语164篇、法语16篇、日语8篇、德语7篇、西班牙语7篇、意大利语4篇、汉语2篇、丹麦语2篇、荷兰语2篇、瑞典语1篇）,排除40篇无法获取全文的文献,最后得到与SCLS有关的全文文献共173篇、84例SCLS患者.记录SCLS患者病程中Alb、Hct、年龄、性别、体重变化、住院天数和24 h输液量等数据,计算Hct与血浆Alb的差值.按照收集到准确Hct和Alb数据的时间分为发病前基础数值组、发病时数值组和发病后痊愈/出院时数值组,比较病程中不同时间点Hct和Alb的水平以及Hct与血浆Alb差值的差异;用Pearson检验分析Hct与血浆Alb的差值与患者24 h补液量的相关性.结果 ① 从84例SCLS病例中选出同时具有发病时以及治疗后痊愈时Alb和Hct〔或血红蛋白（Hb）〕确切数值的病例共12例,结果显示,发病时Hct与血浆Alb的差值较治疗后痊愈时显著升高（26.33±16.36比0.55±8.81,P＜0.001）.② 从84例SCLS病例中选出同时具有发病前基础值以及发病时Alb和Hct（或Hb）确切数值的病例共17例,结果显示,发病时Hct与血浆Alb的差值较发病前显著升高（15.83±11.37比1.82±7.97,P＜0.001）.③ 从84例SCLS病例中选出同时具有发病时Alb、Hct和24 h补液量的病例共14例,结果显示,发病时Hct与血浆Alb的差值为35.45±19.58 ;24 h补液量平均为（9.82±4.95）L,最高输液量为20 L.Pearson分析显示,发病时Hct与血浆Alb的差值与24 h补液量呈明显正相关（r＝0.578,P＜0.05）.结论 在对1996至2015年可供查询的SCLS病例分析中我们发现：① SCLS发病时Objective To investigate the changes of the difference between hematocrit （Hct） and plasma albumin （Alb） in the course of patients with systemic capillary leak syndrome （SCLS）. Methods 281 case reports on human vascular leaking from the PubMed database from January 1st, 1996 to September 30th, 2015 were screened by systematic review method. Studies related to intracranial vascular leakage or intraocular vascular leakage were excluded. 213 articles related to SCLS were identified （164 in English, 16 in French, 8 in Japanese, 7 in German, 7 in Spanish, 4 in Italian, 2 in Chinese, 2 in Danish, 2 in Dutch, and 1 in Swedish）. Due to the unavailable full text, 40 articles were excluded. A total of 173 articles related to SCLS were screened, of which 84 patients were enrolled. The data of Alb, Hct, age, gender, weight change, the length of hospital stay and 24-hour fluid infusion volume in SCLS patients were recorded, and the difference between Hct and plasma Alb （Hct-Alb） was calculated. According to the time when accurate Hct and Alb data were collected, they were divided into three groups： basic value group before onset, value group at onset and value group at recovery/discharge after onset. The levels of Hct and Alb and Hct-Alb at different time points in the course of the disease were compared. Pearson test was used to analyze the correlation between Hct-Alb and 24-hour fluid infusion volume. Results ① A total of 12 cases with both exact values of Alb and Hct [or hemoglobin （Hb）] at the time of onset and recovery after treatment were selected from 84 cases of SCLS. It was shown that the Hct-Alb at the time of onset was significantly higher than that after treatment （26.33±16.36 vs. 0.55±8.81, P 〈 0.001）. ② A total of 17 cases with both the pre-onset baseline value and the exact values of Alb and Hct （or Hb） at the time of onset were selected from 84 cases of SCLS. It was shown that the Hct-Alb at the time of onset was significantly higher than that of the pre-onset basic va

关 键 词：系统性毛细血管渗漏综合征 血细胞比容 血浆白蛋白 

分 类 号：R543.7[医药卫生—心血管疾病]