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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
张运君,卓小岸,周小曼,戴宛娟.乳酸/白蛋白比值对老年脓毒症并发多器官功能障碍综合征患者的预后评估价值[J].中华老年多器官疾病杂志,2018,17(4):252~256
乳酸/白蛋白比值对老年脓毒症并发多器官功能障碍综合征患者的预后评估价值
Prognostic value of lactate/albumin ratio in the elderly sepsis patients complicated with multiple organ dysfunction syndrome
投稿时间:2017-11-25  修订日期:2018-02-03
DOI:10.11915/j.issn.1671-5403.2018.04.055
中文关键词:  脓毒症;预后;乳酸;白蛋白;多器官功能障碍综合征
英文关键词:sepsis; prognosis; lactic acid; albumin; multiple organ dysfunction syndrome
基金项目:海南省医药卫生科研基金(15A200042)
作者单位E-mail
张运君 海南省人民医院急救中心,海口 570311 zhangyunjun412@126.com 
卓小岸 海南省人民医院急救中心,海口 570311  
周小曼 海南省人民医院急救中心,海口 570311  
戴宛娟 海南省人民医院急救中心,海口 570311  
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中文摘要:
      目的 探讨乳酸/白蛋白比值(Lac/Alb)对老年脓毒症并发多器官功能障碍综合征(MODS)患者的预后评估价值。方法 回顾性研究2015年1月至2017年6月海南省人民医院急诊科和ICU收治的老年脓毒症并发MODS患者162例,根据MODS患者入院后14 d的生存情况,将其分为2组:存活组(n=56)和死亡组(n=106)。检测2组患者治疗后0、24、48 h的乳酸(Lac)、白蛋白(Alb)及Lac/Alb,并记录入院时急性生理学与慢性健康状况量表系统Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分情况。采用SPSS 19.0软件进行数据处理。应用受试者工作特征(ROC)曲线分析Lac、Alb及Lac/Alb对MODS患者的预后评估价值。相关性分析采用Pearson相关分析。结果 死亡组0、24、48 h的Lac[(7.84±2.65) vs(4.58±1.52)mmol/L,(9.23±4.16) vs(3.60±1.18)mmol/L,(10.58±4.72) vs(2.14±0.85)mmol/L]及Lac/Alb[(0.38±0.17) vs(0.19±0.12),(0.51±0.20) vs(0.14±0.08),(0.67±0.23) vs(0.08±0.03)]均显著高于存活组(P<0.05),而Alb[(22.26±4.35) vs(25.38±4.72)g/L,(19.15±4.07) vs(27.14±5.20)g/L,(16.30±3.52) vs(31.73±6.82)g/L]显著低于存活组(P<0.05)。ROC曲线显示,Lac/Alb48h的最佳截断点为0.45时,预测MODS患者预后的敏感度(93.6%)和特异度(86.5%)最好。Lac/Alb48h与APACHEⅡ(r=0.725)和SOFA(r=0.806)评分呈显著正相关(P<0.01)。结论 Lac/Alb与MODS患者的病情严重程度及预后密切相关,Lac/Alb48h预测MODS患者预后的价值较高。
英文摘要:
      Objective To investigate the prognostic value of the ratio of lactic acid to albumin (Lac/Alb) in elderly patients with sepsis complicated with multiple organ dysfunction syndrome (MODS). Methods A retrospective study was performed on 162 elderly patients with sepsis complicated with MODS who admitted in the First Aid Center and ICU of our hospital from January 2015 to June 2017. They were divided into survival group (n=56) and death group (n=106) according to their 14-day survival. The changes of Lac, Alb and Lac/Alb ratio in 0,4 and 48 h after treatment were studied, and the scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA) at admission were recorded in the 2 groups. SPSS statistics 19.0 was used for data processing. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of Lac, Alb and Lac/Alb ratio in MODS patients. Pearson correlation analysis was also used. Results At 0,4 and 48 h after treatment, the death group had significantly higher Lac [(7.84±2.65) vs (4.58±1.52)mmol/L, (9.23±4.16) vs (3.60±1.18)mmol/L, (10.58±4.72) vs (2.14±0.85) mmol/L] and Lac/Alb ratio [(0.38±0.17) vs (0.19±0.12), (0.51±0.20) vs (0.14±0.08), (0.67±0.23) vs (0.08±0.03)], but obviously lower Alb [(22.26±4.35) vs (25.38±4.72)g/L, (19.15±4.07) vs (27.14±5.20)g/L, (16.30±3.52) vs (31.73±6.82)g/L], when compared with the survival group (P<0.05). The results of ROC curve showed that when the best cut-off value of Lac/Alb ratio at 48 h was 0.45, the ratio well predicted the prognosis of MODS with a sensitivity of 93.6% and a specificity of 86.5%. Lac/Alb ratio at 48 h was positively correlated to APACHE Ⅱ (r=0.725, P<0.01) and SOFA scores (r=0.806, P<0.01). Conclusion Lac/Alb ratio is closely related to the severity and prognosis of patients with MODS, and the ratio at 48 h is of higher value in predicting the prognosis.
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