尿微量白蛋白测定及ACR对重症感染患者预后判断的意义

Positive detection rate and prognostic significance of microalbuminuria and albumin/urine creatinine ratio in severe infection

目的比较急诊抢救室脓毒症、全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）与非SIRS患者尿微量白蛋白与尿肌酐之比（albumin／creatinine ratio，ACR）阳性检出率的差异及对于死亡预后的意义。方法选取2009—10—2010—10北京朝阳医院急诊抢救室危重病患者132例，将所有入选病例分为3组：脓毒症组（n=37），SIRS组（n=61）及非SIRS组（n=34），检测3组病例的尿微量白蛋白及尿肌酐水平，并计算ACR≥2．5mg ／mmol的阳性检出率，统计3组病例28d病死率，研究ACR、APACHEII评分对于3组病例28d病死率的预测价值。结果ACR的阳性检出率在脓毒症组与非SIRS组之间比较差异有统计学意义（P〈0．01），SIRS组与非SIRS组之间比较差异有统计学意义（P〈0．05），但脓毒症组与SIRS组比较差异无统计学意义（P=0．413）。ACR≥2．5mg／mmol时，脓毒症组、SIRS组患者28d病死率与非SIRS组患者比较差异有统计学意义（P〈0．01）。脓毒症组ACR与APACHEⅡ评分之间呈正相关（P〈0．001）。ACR与APACHEⅡ评分是脓毒症组28d死亡的独立预测因素。结论SIRS患者和脓毒症组ACR阳性率较非SIRS组明显升高，并且脓毒症组ACR是预后不良的指标。

Objective Positive rate of albumin/urine creatinine ratio（ACR） was compared in sepsis, systemic inflammatory response syndrome （SIRS）and non -SIRS patients, and prognostic value was evaluated in emergency department. Methods From December 2009 to December 2010, 132 patients in the emergency department of Beijing Chaoyang Hospital of the Capital Medical University were included in the study and were classified into three groups： sepsis group（n =37）, SIRS group （ n = 61 ） and non -SIRS group （n = 34）. The ACR level was examined in each patient. The positive detection rate of ACRe〉2.5 mg/mmol was calculated and the 28 - day mortality was recorded in each patient. The positive detection rate and 28 - day mortality were compared by chi - square test. The prognostic values of ACR and Acute Physiology and Chronic Health Evaluation Ⅱ （ APACHE Ⅱ） score for the 28 - day mortality were investigated by Logistic regression analysis. Results The positive detection rate of ACR had significant difference between sepsis group and non - SIRS group（ P 〈 0.01 ） as well as between SIRS group and non - SIRS group （P 〈 0.05 ）, while had no significant difference between sepsis group and SIRS group（P =0.413）. When ACR was more than 2.5 mg/mmol, significant difference was found in the 28 -day mortality of SIRS group and sepsis group in comparison to those of non - SIRS group（ P 〈 0. 01 ）. ACR level in sepsis group showed positive correlation to APACHE Ⅱ score （ P 〈 0. 001 ）. Conclusion The positive rates of ACR in SIRS group and septic group were significantly higher thanthose of non - SIRS group, and ACR in sepsis group should be a marker of poor prognosis.