前白蛋白在预测神经危重症患者急性期肌容积减少中的价值研究

Predictive value of prealbumin for acute skeletal muscle wasting in neurocritical patients

目的探讨血清前白蛋白对神经危重症患者急性期肌容积减少的预测价值。方法前瞻性纳入2016年9月～2017年6月第四军医大学附属西京医院神经重症监护病房收住的急性期神经危重症患者,依据入院时血清前白蛋白水平将患者分为前白蛋白正常组(前白蛋白≥0.2 g/L)和前白蛋白低下组(前白蛋白<0.2 g/L),测量、记录并比较两组患者入院第1 d、第3 d、第7 d的大腿和小腿周径变化情况。结果最终纳入93例患者进行研究,前白蛋白正常组48例,前白蛋白低下组45例。两组患者入院时一般情况及干预措施等临床资料的差异无统计学意义。两组入院第1 d大腿周径、小腿周径比较差异无统计学意义。入院第3d和第7 d,前白蛋白低下组下肢周径减少明显大于前蛋白正常组(均P<0.01)。结论入院时血清前白蛋白低下的神经危重症患者急性期肌容积减少显著,应给予针对性的预防与治疗。

Objective To analyze the predictive value of prealbumin for acute skeletal muscle wasting in neurocritical patients. Methods Neurocritical patients admitted to neurological intensive care unit of Xijing Hospital during September 2016 to June 2017 were prospectively enrolled in this study. All the patients were divided into normal prealbumin group（prealbumin≥0. 2 g/L） and low prealbumin group（prealbumin 〈 0. 2 g/L） according to their levels of serum prealbumin on admission. The changes of lower limb circumference on 1 d,3 d,and 7 d were recorded and analyzed. Results Finally,93 patients were enrolled in the study,48 patients with the normal prealbumin group and 45 patients with the low prealbumin group. There was no statistically significant difference between the two groups in the general situation and the intervention measures. There was no statistically significant difference between the two groups in the thigh circumference and the lower leg circumference at 1 d after admition. At3 d and 7 d after admition,the decrease of lower limb circumference of low prealbumin group was significantly greater than that in the normal prealbumin group（all P 〈 0. 01）. Conclusion The muscle wasting is more significant in neurocritical patients with lower prealbumin on admission,for whom more targeted and individualized prevention and treatment are required.