血氨、血乳酸、β_(2)-微球蛋白在急诊感染致脓毒症患者预后预测中的价值分析  

Value of blood ammonia and serum lactic acid and β_(2)-microglobulin in predicting prognosis of patients with sepsis caused by infection in emergency department

作　　者：尹松林[1] 蒲蓉 麦超[1] 牟天易 Yin Songlin;Pu Rong;Mai Chao;Mou Tianyi(Department of Emergency Medicine,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Pediatrics,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院急诊科,四川南充637000 [2]川北医学院附属医院儿科,四川南充637000

出　　处：《中华临床医师杂志（电子版）》2022年第6期507-512,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析血氨、血清乳酸(LAC)、血清β_(2)-微球蛋白(β_(2)-MG)在急诊感染致脓毒症患者预后预测中的价值,为临床诊断和治疗工作提供依据。方法选择2020年3月至2021年3月川北医学院附属医院EICU收治的90例感染致脓毒症患者作为研究对象,回顾性分析其确诊后28 d内存活情况,根据其预后将其分为死亡组(21例)和存活组(69例)。对2组患者的基础资料和确诊当日的实验室指标进行比较,分析与患者预后相关的因素,采用受试者工作特征(ROC)曲线分析相关指标预测患者预后的价值。结果死亡组患者合并糖尿病、慢性肾病的比例及确诊当日的急性生理与慢性健康评估系统Ⅱ(APACHEⅡ)评分分别为42.86%(9/21)、47.62%(10/21)、(26.72±5.34),均高于存活组(P<0.05)。死亡组患者确诊当日的血氨、LAC、β_(2)-MG、降钙素原(PCT)水平分别为(115.56±38.17)μmol/L、(3.87±0.92)mmol/L、(6.91±1.32)mg/L、(3.96±0.66)μg/L,均高于存活组(P<0.05)。Logistic多元回归模型分析结果显示,确诊当日的APACHEⅡ评分、血氨、LAC、β_(2)-MG水平是急诊脓毒症患者死亡的独立危险因素(P<0.05)。APACHEⅡ评分、血氨、LAC、β_(2)-MG预测急诊脓毒症患者预后的ROC曲线下面积(AUC^(ROC))分别为0.705、0.827、0.663、0.815(P<0.05),其中,血氨的AUC^(ROC)最高,在最佳界值下,β_(2)-MG的敏感度最高,LAC的特异度最高。结论血氨、血清LAC、血清β_(2)-MG等标志物对于早期预测急诊感染致脓毒症患者的预后均具有一定的辅助价值,临床医生应根据其各自优势灵活运用多种标志物以提高预测效率,达到改善患者预后的目的。Objective To assess the value of blood ammonia and serum lactic acid(LAC)andβ_(2)-microglobulin(β_(2)-MG)in predicting the prognosis of patients with sepsis caused by infection in emergency department,so as to provide a basis for its clinical diagnosis and treatment.Methods A total of 90 patients with sepsis who were admitted to the Emergency Intensive Care Unit of Affiliated Hospital of North Sichuan Medical College from March 2020 to March 2021 were selected as the study subjects.Their survival within 28 days after diagnosis was analyzed retrospectively,and they were divided into either a death group(21 cases)or a survival group(69 cases)according to their prognosis.The basic data and laboratory indexes at the day of diagnosis were compared between the two groups,and the factors related to the prognosis were analyzed.Receiver operating characteristic(ROC)curve analysis was performed to assess their value in predicting the prognosis of the patients.Results The proportions of patients with diabetes and chronic kidney disease and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score at the day of diagnosis were 42.86%(9/21),47.62%(10/21),and(26.72±5.34)in the death group,respectively,which were significantly higher than the corresponding values in the survival group(P<0.05).Blood ammonia and serum LAC,β_(2)-MG,and procalcitonin(PCT)levels were(115.56±38.17)μmol/L,(3.87±0.92)mmol/L,(6.91±1.32)mg/L,and(3.96±0.66)μg/L in the death group,respectively,which were higher than the corresponding values in the survival group(P<0.05).Logistic multiple regression analysis showed that APACHEⅡscore,blood ammonia,and serum LAC andβ_(2)-MG at the day of diagnosis were independent risk factors for the death of patients with sepsis(P<0.05).The area under the ROC curve(AUC^(ROC))values of APACHEⅡscore,blood ammonia,and serum LAC andβ_(2)-MG in predicting the prognosis of the patients with sepsis were 0.705,0.827,0.663,and 0.815,respectively(P<0.05),of which the AUC^(ROC) of blood ammonia was the highe

关 键 词：血氨 乳酸 β_(2)-微球蛋白 急诊 脓毒症 预后 

分 类 号：R459.7[医药卫生—急诊医学]