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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 654 -657. doi: 10.3877/cma.j.issn.1674-6902.2023.05.010

临床研究

急性低氧性呼吸衰竭乳酸/白蛋白比值与病死率相关性分析
程玲燕, 卢嘉宾, 韦庆, 兰祖†()   
  1. 547000　河池，河池市人民医院·右江民族医学院附属河池医院呼吸与危重症医学科
  • 收稿日期:2023-02-02 出版日期:2023-10-25
  • 通信作者: 兰祖
  • 基金资助:
    河池市科技计划项目(河科AB193607)

Correlation analysis of lactate/albumin ratio and mortality in acute hypoxemic respiratory failure

Lingyan Chen, Jiabin Lu, Qing Wei   

  • Received:2023-02-02 Published:2023-10-25
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程玲燕, 卢嘉宾, 韦庆, 兰祖. 急性低氧性呼吸衰竭乳酸/白蛋白比值与病死率相关性分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 654-657.

Lingyan Chen, Jiabin Lu, Qing Wei. Correlation analysis of lactate/albumin ratio and mortality in acute hypoxemic respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(05): 654-657.

目的

分析乳酸/白蛋白比值(LAR)与急性低氧性呼吸衰竭(AHRF)病死率的相关性。

方法

选择2019年4月至2022年12月我院收治的AHRF患者39例为对象，主要结局随访60 d内全因病死率，分为预后不良14例及预后良好25例；次要结局院内病死率。检测动脉血乳酸水平，血清白蛋白水平，计算LAR。

结果

预后不良者LAR高[2.00(1.07，3.02)vs. 1.03(0.68，1.97)，Z＝－2.753，P＝0.006]。ROC曲线分析显示LAR对AHRF 60 d内预测曲线下面积(AUC)0.873[95%置信区间：0.796~0.950]高于急性生理与慢性健康评分Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)、序贯器官衰竭(SOFA)及动脉血氧分压/吸入气体氧含量(P/F)比值、动脉血氧饱和度/吸入气体氧含量(S/F)比值。联合检测LAR提高APACHEⅡ、SAPSⅡ、SOFA及S/F比值、P/F比值预测。单因素及多因素分析显示插管时长≤9 d、气管造瘘、氧合指数≤180 mmHg、28 d无机械通气时间<16 d及LAR>1.60是AHRF 60 d内死亡危险因素。多元COX比例风险回归模型分析显示LAR>1.60院内死亡风险上升。

结论

LAR是AHRF短期(60 d和院内)全因病死率的危险因素，为AHRF提供预后信息。

关键词: 急性低氧性呼吸衰竭, 血乳酸, 白蛋白, 预后
表1 急性低氧性呼吸衰竭ROC曲线分析
变　量 AUC P值 灵敏度(%) 特异度(%) 约登指数 截断值 渐进95%CI
下限 上限
单独预测                
APACHEⅡ 0.770 0.000 87.9 52.5 0.404 26.50 0.670 0.870
SAPSⅡ 0.786 0.000 75.8 72.1 0.479 64.50 0.685 0.887
SOFA 0.757 0.000 63.6 82.0 0.456 14.50 0.648 0.866
S/F比值 0.741 0.000 54.5 90.2 0.447 154.00 0.629 0.854
P/F比值 0.805 0.000 84.8 67.2 0.328 181.50 0.709 0.900
LAR 0.873 0.000 84.8 83.6 0.684 1.60 0.796 0.950
联合预测                
LAR＋APACHEⅡ 0.871 0.000 84.8 85.2 0.700 0.28 0.795 0.948
LAR＋SAPSⅡ 0.879 0.000 75.8 90.2 0.660 0.43 0.804 0.953
LAR＋SOFA 0.874 0.000 91.9 86.9 0.687 0.34 0.797 0.952
LAR＋S/F比值 0.877 0.000 87.9 82.0 0.699 0.30 0.796 0.957
LAR＋P/F比值 0.888 0.000 87.9 80.3 0.682 0.27 0.815 0.962
表2 多元COX比例风险回归模型分析
指　标 β SE Walds值 HR(95%CI) P值
吸烟史(否vs.是) －0.398 0.511 0.605 0.672(0.247~1.831) 0.437
插管时长(≤9 d vs. >9 d) －0.060 0.026 5.434 0.942(0.896~0.991) 0.020
气管造瘘(否vs.是) 2.334 0.996 5.490 10.319(1.465~72.710) 0.019
S/F比值(≤154.00 vs. >154.00) 1.548 0.946 2.675 4.700(0.736~30.026) 0.102
P/F比值(≤181.50 vs. >181.50) －0.004 0.006 0.411 0.996(0.984~1.008) 0.522
28 d无机械通气时间(<16 d vs. ≥16 d) －2.357 0.985 5.723 0.095(0.014~0.653) 0.017
LAR(≤1.60 vs. >1.60) 0.503 0.244 4.258 1.654(1.026~2.666) 0.039
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