早期血清白蛋白水平对重型颅脑损伤术后患者预后的预测价值  

Predictive value of early serum albumin level on prognosis of patients after severe traumatic brain injury

作　　者：蒋文 胡小义 李鹏飞 赵雪 章艺 赵文静 JIANG Wen;HU Xiao-Yi;LI Peng-Fei;ZHAO Xue;ZHANG Yi;ZHAO Wen-Jing(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Intensive Care Unit,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000 [2]徐州医科大学附属医院重症医学科,江苏徐州221000

出　　处：《中华老年多器官疾病杂志》2021年第5期343-348,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的评估早期血清白蛋白(ALB)水平用于预测重型颅脑损伤(STBI)术后患者预后的价值。方法采用回顾性研究方法,选取2015年9月至2020年6月徐州医科大学附属医院重症医学科收治的年龄≥18岁、ICU住院时间>7d的149例STBI术后患者为研究对象,根据28d生存情况将其分为存活组和死亡组。收集患者一般资料,入ICU 1、3、5、7d的血清ALB水平,1~3、4~5、6~7d ALB补充量。采用多因素logistic回归分析影响预后的独立危险因素。通过动态ALB水平及急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分绘制受试者工作特征曲线(ROC),评估其预测28d预后的价值;基于相应时间点ALB临界值分组,通过Kaplan-Meier生存曲线分析累积生存率。结果149例患者中,28d内死亡41例,病死率为27.5%。治疗时间延长情况下,存活组血清ALB水平呈逐渐上升趋势,死亡组呈先下降后升高趋势,死亡组3d血清ALB水平最低。相较存活组,死亡组入ICU 3、5、7d血清ALB水平皆明显偏低[(35.22±0.54)和(25.99±0.60),(36.58±0.54)和(32.29±4.25),(36.70±0.49)和(34.66±0.79)mmol/L,均P<0.05)]。分析ROC曲线可知,在预测STBI术后患者28d死亡方面,入ICU 3d与5d血清ALB具有较高的价值,ROC曲线下面积(AUC)依次是0.928和0.892(均P<0.001);APACHEⅡ评分及入ICU 7d血清ALB水平次之,两者AUC依次是0.801和0.616(均P<0.05)。以3d血清ALB 31.2g/L当作预测28d死亡的临界值时,其灵敏度为95.12%,特异度为81.48%,阳性似然比为3.02,阴性似然比为0.07。分析Kaplan-Meier生存曲线可知,入ICU不同时间点,高于血清ALB临界值者28d存活率明显比低于临界值者高,且生存期更长。3d时血清ALB>31.2g/L者28d存活率明显高于血清ALB≤31.2g/L者,且生存期显著延长[28d存活率:96.7%(89/92)和32.8%(19/57),χ^(2)=68.068,P<0.001;生存期(d):26.46(23.96,30.11)和24.26(19.93,28.46),Z=3.423,P=0.001〕。结论血清ALB水平下降代表STBI术后患者预后不佳;入ICU 3 d血清ALB水平对STBObjective To evaluate the value of early serum albumin(ALB)levels for predicting the prognosis of patients with severe traumatic brain injury(STBI).Methods A retrospective study was of 149 postoperative STBI patients who were aged over 18 and stayed over 7 days in the Intensive Care Unit of the Affiliated Hospital of Xuzhou Medical University from September 2015 to June 2020.Based on 28-day survival,the patients were divided into survival group and death group.Data were collected of the patient′s basic information,serum albumin levels at d 1,3,5 and 7,and supplementary albumin volume at d 1-3,d 4-5,d 6-7.Multivariate logistic regression analysis was performed for independent risk factors affecting prognosis.Receiver operating characteristic(ROC)curve was drawn based on dynamic ALB levels and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score to evaluate the predictive value for 28-day survival.The patients were grouped based on the ALB cut-off value at the corresponding time point,and Kaplan-Meier survival curve was used for analyzing the cumulative survival rate.Results Of 149 patients,41 died in 28 days,with a fatality rate of 27.5%.With the prolonged treatment,the ALB level of the survival group showed a trend of gradual increase.The death group showed a decrease-increase trend of ALB levels,reaching the lowest at d 3.On d 3,5,and 7 of ICU stay,the ALB levels in the death group were significantly lower than that in the survival group[(35.22±0.54)vs(25.99±0.60),(36.58±0.54)vs(32.29±4.25),(36.70±0.49)vs(34.66±0.79)mmol/L,P<0.05 for all).Analysis of the ROC curve showed that in predict-ing the 28-day death of patients with severe brain injury,the ALB levels at d 3 and d 5 of ICU stay had the highest value,and the area under the ROC curve(AUC)was 0.928 and 0.892(both P<0.001).APACHEⅡscore and the ALB level at d 7 of ICU stay were the second,and the AUC of the two were 0.801 and 0.616(P<0.05 for both).Using the ALB of 31.2 g/L at d 3 as the critical value for predicting 28-d death,it yielde

关 键 词：颅脑损伤 血清白蛋白 预后 APACHEⅡ评分 

分 类 号：R651.1[医药卫生—外科学]