急性呼吸窘迫综合征患者发生低磷血症的危险因素分析  

Analysis of the risk factors of hypophosphatemia in patients with acute respiratory distress syndrome

作　　者：王洁 许惠仙 Wang Jie;Xu Huixian(Department of Clinical Nutrition,Yanbian University Affiliated Hospital,Yanji 133000,Jilin,China)

机构地区：[1]延边大学附属医院临床营养科,吉林延吉133000

出　　处：《中华危重病急救医学》2025年第1期43-47,共5页Chinese Critical Care Medicine

基　　金：吉林省教育厅科学技术研究项目(JJKH20220550KJ)。

摘　　要：目的分析急性呼吸窘迫综合征(ARDS)患者发生低磷血症的危险因素。方法采用回顾性病例对照研究方法,收集2018年1月至2022年10月延边大学附属医院收治的110例ARDS患者的临床资料。根据患者入重症监护病房(ICU)1 d血清磷水平,将血清磷水平正常(0.80~1.45 mmol/L)或偏高(>1.45 mmol/L)的患者纳入非低磷组,将低磷血症患者纳入低磷组(血清磷水平<0.80 mmol/L)。比较两组患者入ICU 1、2、4、6、8 d炎症指标〔中性粒细胞比例(NEU%)、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、超敏C-反应蛋白(hs-CRP)〕、蛋白质〔总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)〕、血乳酸(Lac)、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞/白蛋白比值(NAR)、血乳酸/白蛋白比值(L/A)的差异;采用偏相关法分析入ICU 1 d血清磷水平与上述指标的相关性;采用多因素Logistic回归分析探讨ARDS患者发生低磷血症的危险因素。结果110例患者均纳入最终分析,其中低磷组56例,非低磷组54例。低磷组患者入ICU 1 d、2 d NEU%即较非低磷组显著升高(1 d:0.87±0.08比0.82±0.12,2 d:0.87±0.05比0.83±0.11,均P<0.05);随入ICU时间延长,低磷组患者LYM呈上升趋势,NEU%、hs-CRP、NLR呈先下降后升高趋势。低磷组入ICU 1 d TP、Alb、PA均较非低磷组显著降低〔TP(g/L):52.96±8.42比56.47±8.36,Alb(g/L):29.73±5.83比33.08±7.35,PA(g/L):69.95±50.72比121.50±82.42,均P<0.05〕;随入ICU时间延长,低磷组患者TP、Alb均呈先下降后升高趋势,但8 d Alb仍低于1 d,PA呈上升趋势。非低磷组TP、Alb的变化趋势与低磷组一致。Lac、L/A在两组组内均呈下降趋势。偏相关分析显示,入ICU 1 d血清磷水平与NEU%、hs-CRP呈显著负相关(r值分别为-0.229、-0.286,均P<0.05),与LYM、PA呈显著正相关(r值分别为0.231、0.311,均P<0.05)。多因素Logistic回归分析显示,入ICU 1 d NEU%〔优势比(OR)=0.932,95%可信区间(95%CI)为0.873~0.996,P=0.038〕和Alb(OR=1.1Objective To analyze the risk factors of hypophosphatemia in patients with acute respiratory distress syndrome(ARDS).MethodsA retrospective case-control study was conducted.The clinical data of the patients with ARDS admitted to Yanbian University Affiliated Hospital from January 2018 to October 2022 were collected.According to the 1-day serum phosphorus level after intensive care unit(ICU)admission,the patients with normal(0.80-1.45 mmol/L)or elevated(>1.45 mmol/L)serum phosphorus levels were included in the non-hypophosphatemia group,while those with phosphorus levels lower than 0.80 mmol/L were included in the hypophosphatemia group.The differences in the inflammatory indicators[neutrophils percentage(NEU%),neutrophil count(NEU),lymphocyte count(LYM),high-sensitivity C-reactive protein(hs-CRP)],proteins[total protein(TP),albumin(Alb),prealbumin(PA)],blood lactic acid(Lac),neutrophil/lymphocyte ratio(NLR),neutrophil/albumin ratio(NAR),and blood lactic acid/albumin ratio(L/A)at 1,2,4,6 and 8 days after ICU admission were compared between the two groups.The partial correlation method was used to analyze the correlation between the 1-day serum phosphorus level after ICU admission and the above indicators.Multivariate Logistic regression analysis was adopted to explore the risk factors of hypophosphatemia in patients with ARDS.ResultsAll 110 patients were enrolled in the final analysis,among which there were 56 cases in the hypophosphatemia group and 54 cases in the non-hypophosphatemia group.At 1 day and 2 days after ICU admission,NEU%in the hypophosphatemia group were significantly higher than those in the non-hypophosphatemia group(1 day:0.87±0.08 vs.0.82±0.12,2 days:0.87±0.05 vs.0.83±0.11,both P<0.05).As the ICU admission time prolonged,LYM in the hypophosphatemia group was basically on the rise,and NEU%,hs-CRP,and NLR were first decreased and then increased.At 1 day after ICU admission,TP,Alb and PA in the hypophosphatemia group were significantly lower than those in the non-hypophosphatemia group[TP(g/L):

关 键 词：急性呼吸窘迫综合征 低磷血症 危险因素 

分 类 号：R563.8[医药卫生—呼吸系统]