碱性磷酸酶与白蛋白比值对多发伤患者创伤脓毒症的诊断及预后评估意义  

Significance of alkaline phosphatase to albumin ratio in the diagnosis and prognosis evaluation of trauma sepsis in patients with multiple trauma

作　　者：贾映茂 陶宁[1] 杨波[1] 何诚[1] 胡建平[1] JIA Yingmao;TAO Ning;YANG Bo;HE Cheng;HU Jianping(Department of Emergency Medicine,Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院急诊医学科,四川遂宁629000

出　　处：《国际检验医学杂志》2024年第19期2382-2385,2391,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨碱性磷酸酶与白蛋白比值(APAR)对多发性创伤(简称多发伤)患者创伤脓毒症的诊断及预后评估意义。方法选取2021年1月至2023年10月于该院治疗的130例多发伤患者为受试者,根据是否发生创伤脓毒症分为脓毒症组(82例)和非脓毒症组(48例)。确诊为创伤脓毒症即日起连续随访28 d,根据预后生存情况分为存活组(67例)和死亡组(15例)。采用全自动生化分析仪检测外周血中碱性磷酸酶、白蛋白水平,并计算APAR。采用受试者工作特征(ROC)曲线评估碱性磷酸酶、白蛋白、APAR对多发伤患者创伤脓毒症的预测价值。采用多因素Logistic回归分析探讨多发伤患者创伤脓毒症预后的影响因素。结果脓毒症组碱性磷酸酶水平和APAR高于非脓毒症组,白蛋白水平低于非脓毒症组(P<0.05)。碱性磷酸酶、白蛋白、APAR预测多发伤患者创伤脓毒症的曲线下面积(95%CI)分别为0.753(0.702~0.801)、0.849(0.798~0.900)、0.901(0.850~0.952),最佳临界值分别为142.12 U/L、27.89 g/L、5.24,特异度分别为55.24%、66.16%、85.43%,灵敏度分别为91.67%、91.67%、84.12%。死亡组碱性磷酸酶水平和APAR高于存活组,白蛋白水平低于存活组(P<0.05)。死亡组年龄≥60岁占比、序贯器官衰竭评分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及C反应蛋白、血乳酸、血肌酐水平高于存活组(P<0.05)。多因素Logistic回归分析结果显示,高龄(OR=2.330,95%CI 1.568~3.462)、APACHEⅡ评分高(OR=2.056,95%CI 1.448~2.921)、碱性磷酸酶高表达(OR=2.479,95%CI 1.652~3.720)、白蛋白低表达(OR=2.525,95%CI 1.543~3.288)、APAR升高(OR=2.849,95%CI 1.848~4.394)是多发伤患者创伤脓毒症预后的影响因素(P<0.05)。结论APAR可作为预测多发伤患者创伤脓毒症的生物学指标,且APAR异常升高与患者创伤脓毒症预后存在关联。Objective To investigate the significance of alkaline phosphatase to albumin ratio(APAR)in the diagnosis and prognosis evaluation of trauma sepsis in patients with multiple trauma.Methods A total of 130 patients with multiple trauma treated in this hospital from January 2021 to October 2023 were selected as subjects.According to the presence or absence of trauma sepsis,they were divided into sepsis group(82 cases)and non-sepsis group(48 cases).The patients with traumatic sepsis were followed up for 28 d and divided into survival group(67 cases)and death group(15 cases)according to the prognosis.The levels of alkaline phosphatase and albumin in peripheral blood were detected by automatic biochemical analyzer,and APAR was calculated.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of alkaline phosphatase,albumin,and APAR for trauma sepsis in patients with multiple trauma.Multivariate Logistic regression analysis was used to explore the influencing factors of the prognosis of trauma sepsis in patients with multiple trauma.Results The levels of alkaline phosphatase and APAR in sepsis group were higher than those in non-sepsis group,and the level of albumin was lower than that in non-sepsis group(P<0.05).The area under the curve(95%CI)of alkaline phosphatase,albumin,and APAR for predicting traumatic sepsis in patients with multiple trauma were 0.753(0.702-0.801),0.849(0.798-0.900),and 0.901(0.850-0.952),respectively.The cut-off values were 142.12 U/L,27.89 g/L and 5.24,the specificity were 55.24%,66.16%and 85.43%,and the sensitivity were 91.67%,91.67%and 84.12%,respectively.The levels of alkaline phosphatase and APAR in the death group were higher than those in the survival group,and the level of albumin was lower than that in the survival group(P<0.05).Compared with the survival group,the death group had significantly higher proportion of patients aged≥60 years,sequential organ failure score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,and levels of C-re

关 键 词：碱性磷酸酶与白蛋白比值 多发性创伤 创伤脓毒症 预后 

分 类 号：R641[医药卫生—外科学]