重症急性胰腺炎患者预后与血浆白蛋白变化相关性分析

Correlation between prognosis of patients with severe acute pancreatitis and changes of plasma albumin

目的探讨重症急性胰腺炎患者预后效果与血浆白蛋白水平变化之间的相关性。方法选取2008年9月至2013年10月收治的235例重症胰腺炎患者为研究对象,根据患者的预后状况分为2组,其中病情好转、至今仍生存的患者共143例,设为存活组,病情恶化而死亡的患者共92例,设为死亡组。回顾性分析2组患者的基本情况以及血浆白蛋白水平变异等,采取logistic回归分析血浆白蛋白变化与重症急性胰腺炎死亡的相关性。结果存活组患者年龄、APCHEⅡ评分、Ranson评分、SOFA评分、总住院时间、机械通气时间、连续肾脏替代治疗、住院期间血浆白蛋白总体水平、24 h内血浆白蛋白下降值以及白蛋白变异度与死亡组比较,差异具有统计学意义(P<0.05);ROC曲线提示24 h内白蛋白下降值预测患者死亡的最佳截断值是4.24 g/L;蛋白变异度预测死亡的最佳截断值是13.6%;logistic回归分析结果表明重症急性胰腺炎死亡的主要危险因素为24 h内白蛋白下降值、24 h内血浆白蛋白变异度、血浆白蛋白总体水平以及APACHEⅡ评分。结论血浆白蛋白变化能够反映重症急性胰腺炎的疾病严重程度,24 h内血浆白蛋白急剧下降可作为患者死亡的危险因素之一。

Objective To investigate the correlation between prognosis of patients with severe acute pancreatitis and changes of plasma albumin. Methods A total of 235 patients with severe pancreatitis who were admitted into hospital from September 2008 to October 2013 were selected as research object. According to the prognosis,they were divided into the survival group（ 143 cases who were recovered and still alive） and the death group（ 92 cases who died of the deterioration of diseases）. Retrospectively analyzed the basic situation of the patients and the changes of serum albumin levels in the two groups. And the correlation between prognosis of patients with severe acute pancreatitis and changes of plasma albumin were evaluated by the logistic regression analysis. Results Compared with the death group,there were significant differences（ P〈0. 05） in terms of age,APCHE Ⅱ score,Ranson score,SOFA score,length of hospital stay,duration of mechanical ventilation,continuous renal replacement therapy,average serum albumin level,decrease of serum albumin within 24 hours,and variation of serum albumin. And ROC curves suggested the best cutoff value of decrease of serum albumin within 24 hours to predict death in patients within 24 hours was 4. 24 g / L,and the best cutoff value of variation of serum albumin to predict death was 13. 6%. Logistic regression analysis showed that the major risk factors of death in severe acute pancreatitis were decrease of serum albumin within 24 hours,variation of serum albumin within 24 hours,average serum albumin level,and the APCHE Ⅱ score. Conclusion Changes in plasma albumin can reflect the severity of severe acute pancreatitis,and the sharp decrease of serum albumin within 24 hours can be used as a risk factor for death.