血清白蛋白水平与早产儿重度脑室内出血病死率相关性

Correlation between serum albumin level and mortality of severe intraventricular hemorrhage in premature infants

目的:观察出生24 h内血清白蛋白水平与≤32周早产儿重度脑室内出血病死率的相关性。方法:选取我院2014年6月30日~2019年5月30日出生的≤32周重度脑室内出血早产儿245例,胎龄均为24~32周。于出生24 h内检测患儿血清白蛋白水平,并对患儿进行随访,观察治疗30天内重度脑室内出血早产儿死亡情况。分析血清白蛋白水平与重度脑室内出血早产儿病死率相关性,并分析病死率影响因素。结果:白蛋白对重度脑室内出血患儿病死率具有预测价值(AUC=0.74,P=0.001),特异度为68.5%,灵敏度为75.9%。白蛋白降低组乳酸水平、败血症、急性呼吸窘迫综合症、母亲合并子痫前期比例高于白蛋白升高组,差异具有统计学意义。Kaplan-Meier法并Log-rank检验分析显示,白蛋白降低患儿生存期短于白蛋白增高患儿。单因素分析结果显示,孕周、出生体质量、败血症、急性呼吸窘迫综合症、乳酸水平、凝血功能障碍、白蛋白水平是重度脑室内出血患儿病死率的影响因素。多因素COX比例风险模型显示,白蛋白、败血症、急性呼吸窘迫综合症、出生体质量是重度脑室内出血患儿病死率的独立影响因素。结论:白蛋白水平可用于预测严重脑室内出血早产儿预后,出生24 h内血清白蛋白水平降低(<24 g/L)的严重脑室内出血早产儿病死率高。

Objective To observe the correlation between serum albumin levels within 24 hours of birth and the severity of intraventricular hemorrhage(IVH)in≤32 weeks of preterm infants.Mehtods A total of 245 preterm infants with severe IVH who were born in our hospital from June 30,2014 to May 30,2019 were enrolled.The gestational age was 24-32 weeks.Serum albumin levels were measured within 24 hours of birth,and the children were followed up to observe the death rate within 30 days of treatment.The correlation between serum albumin level and mortality of severe IVH premature infants was analyzed,and the influencing factors of mortality were analyzed.Results Albumin had predictive value for mortality in children with severe IVH(AUC=0.74,P=0.001),the specificity was 68.5%,and the sensitivity was 75.9%.The albumin-lowering group had higher levels of lactate,sepsis,acute respiratory distress syndrome,and pre-eclampsia in mothers than those in albumin-increased group.Kaplan-Meier and Log-rank test showed that the survival time of the albumin-lowering group was shorter than that of the albumin-increased group.Univariate analysis showed that gestational age,birth weight,sepsis,acute respiratory distress syndrome,lactate level,coagulopathy,and albumin levels were the influencing factors of mortality in children with severe IVH.The multivariate COX proportional hazard model showed that albumin,sepsis,acute respiratory distress syndrome,and birth weight were independent factors in the mortality of children with severe IVH.Conclusion Albumin levels can be used to predict the prognosis of severe IVH preterm infants.The mortality of severe IVH preterm infants with low serum albumin levels(<24g/L)within 24 hours of birth is high.