脓毒症患者hs-CRP/ALB和hs-CRP/PA与膈肌功能障碍的相关性  

Correlation of hs-CRP/ALB and hs-CRP/PA with diaphragmatic function in sepsis patients

作　　者：马金兰 丁欢[1] 杨晓军[1] 丁永安 杨红晓[1] 杨光飞[3] 王晓红[1] Ma Jinlan;Ding Huan;Yang Xiaojun;Ding Yongan;Yang Hongxiao;Yang Guangfei;Wang Xiaohong(Intensive Care Unit,the General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院重症医学科,宁夏银川750004 [2]宁夏大学法学院,宁夏银川750004 [3]宁夏医科大学总医院超声科,宁夏银川750004

出　　处：《中国急救医学》2023年第9期704-710,共7页Chinese Journal of Critical Care Medicine

基　　金：宁夏回族自治区重点研发计划项目(2021BEG03064)。

摘　　要：目的探讨超敏C反应蛋白与血清白蛋白比值(hs-CRP/ALB)和超敏C反应蛋白与前白蛋白比值(hs-CRP/PA)与脓毒症膈肌功能障碍的相关性。方法采用前瞻性观察性研究方法,选择2020年1月至2021年5月入住宁夏医科大学总医院重症医学科(ICU)的80例脓毒症患者为研究对象,以入ICU第1天床旁超声测量膈肌位移(diaphragmatic excursion,DE)<10 mm诊断为膈肌功能障碍,将其分为脓毒症膈肌功能障碍组(n=29)和脓毒症非膈肌功能障碍组(n=51),并选择年龄、性别与研究对象相匹配的30例普通术后非脓毒症患者和15例健康志愿者为术后对照组和正常对照组。收集临床资料,动态观察脓毒症患者超敏C反应蛋白(hyper-sensitive C-reactive protein,hs-CRP)、血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)等指标,计算hs-CRP/ALB和hs-CRP/PA。并用间接测热法测量脓毒症患者静息能量消耗水平,计算静息能量消耗水平与实际给予能量的差值,即能量缺失值。结果①入ICU第1天,脓毒症膈肌功能障碍组、脓毒症非膈肌功能障碍组和术后对照组DE均低于正常对照组(均P<0.05),且脓毒症膈肌功能障碍组DE低于脓毒症非膈肌功能障碍组和术后对照组[mm:8.8(6.7,9.3)vs.13.3(12.3,17.8)和12.9(10.5,15.7),P<0.05];脓毒症膈肌功能障碍组能量缺失值高于脓毒症非膈肌功能障碍组(P<0.05)。②入ICU第1、3、7天,脓毒症膈肌功能障碍组hs-CRP/ALB高于脓毒症非膈肌功能障碍组[第1天:7.73(3.95,9.15)vs.5.44(2.76,8.14);第3天:4.63(3.12,6.17)vs.2.60(1.04,5.09);第7天:2.21(0.84,5.84)vs.0.81(0.52,2.36),均P<0.05]。脓毒症膈肌功能障碍组hs-CRP和hs-CRP/PA仅入ICU第3天高于脓毒症非膈肌功能障碍组[hs-CRP(mg/L):150.0(92.4,169.0)vs.62.5(30.3,152.0);hs-CRP/PA:1.74(1.12,2.73)vs.0.78(0.21,1.97),均P<0.05]。两组间各时相点ALB、PA比较差异均无统计学意义(均P>0.05)。脓毒症膈肌功能障碍组入ICU第1天hs-CRP/ALB、hs-CRP/PA均高于第7天(P<0.Objective To explore the correlation of hypersensitive C-reactive protein to serum albumin ratio(hs-CRP/ALB)and hypersensitive C-reactive protein to prealbumin ratio(hs-CRP/PA)with diaphragmatic dysfunction in sepsis patients.Methods By using a prospective observational study approach,80 sepsis patients admitted to Intensive Care Unit(ICU)of the General Hospital of Ningxia Medical University from January 2020 to May 2021 were selected as the study subjects.On 1st day of ICU admission,diaphragmatic excursion(DE)<10 mm measured by bedside ultrasound was diagnosed as diaphragmatic dysfunction.The patients were divided into septic diaphragmatic dysfunction group(n=29)and septic non-diaphragmatic dysfunction group(n=51).General postoperative non-sepsis patients(n=30)and healthy volunteers(n=15)with matched age and sex were selected as postoperative control and normal control groups.Clinical data were collected to dynamically observe the hypersensitive C-reactive protein(hs-CRP),serum albumin(ALB),and prealbumin(PA)levels in sepsis patients,and hs-CRP/ALB and hs-CRP/PA were calculated.The resting energy consumption level of septic patients was measured by indirect heating method,and the difference between the resting energy consumption level and the actual given energy was calculated,that is,the missing energy value.Results①On 1st day of ICU admission,the DE in the septic diaphragmatic dysfunction group,theseptic non-diaphragmatic dysfunction group and the postoperative control group were all lower than thatin the normal control group(all P<0.05).Moreover,the DE in the septic diaphragmatic dysfunctiongroup was lower than that in the septic non-diaphragmatic dysfunction group and the postoperativecontrol group[mm;8.8(6.7,9.3)vs.13.3(12.3,17.8)and 12.9(10.5,15.7),P<0.05];Themissing energy value was higher in the septic diaphragmatic dysfunction grup than that in the septicnon-diaphragmatic dysfunction group(P<0.05).②On 1st,3rd and 7th day of ICU admission,hs-CRP/ALB was higher in the septic diaphragmatic dysfunction

关 键 词：脓毒症 膈肌功能 超敏C反应蛋白与血清白蛋白比值(hs-CRP/ALB) 超敏C反应蛋白与前白蛋白比值(hs-CRP/PA) 相关性 

分 类 号：R459.7[医药卫生—急诊医学]