强离子隙等指标对儿童重症肺炎预后的评估价值

Evaluation of strong ion gap and other indicators on prognosis of severe pneumonia in children

目的探究强离子隙（strong ion gap，SIG）、阴离子间隙（anion gap，AG）、根据白蛋白校正的阴离子间隙（albumin-corrected anion gap，ACAG）、乳酸指标对儿童重症肺炎预后的评估价值。方法收集2014年6月至2017年6月川北医学院附属医院儿科重症肺炎住院患儿79例为研究对象，据病情预后分为死亡组20例，存活组59例，统计入院时测定的血气分析、血生化等相关指标获取Na＋、K＋、Cl－、HCO3－、Mg2＋、Ca2＋、pH、PaCO2、P、白蛋白及乳酸等数据，并在此基础上采用Henderson-hasselbalach公式计算ACAG，SIG的计算则采用Stewart-Figge公式。结果两组患儿的ACAG、SIG、乳酸水平差异均有统计学意义（P均〈0.05）。ACAG的ROC曲线下面积0.756，大于诊断参考线下面积，结果有统计学意义（P〈0.05），灵敏度、特异度分别为79.7%、70.0%，截断值为12.7；SIG的ROC曲线下面积0.936，大于诊断参考线下面积，结果有统计学意义（P〈0.05），灵敏度、特异度分别为81.4%、95.5%，截断值为2.7。结论SIG、ACAG、乳酸对于评估儿童重症肺炎预后均有指导价值，其中SIG对于儿童重症肺炎预后的评估有更大的指导意义。

ObjectiveTo investigate the value of strong ion gap （SIG）, anion gap （AG）, and the anionic gap corrected by albumin （ACAG） and lactate in evaluating the prognosis of severe pneumonia in children.MethodsPediatric patients with severe pneumonia hospitalized in the Affiliated Hospital of North Sichuan Medical College from June 2014 to June 2017 were selected as study subjects.A total of 20 death patients （death group） and 59 survivors （survival group） were analyzed respectively according to their prognosis.The data of Na＋ , K＋ , Cl-, HCO3-, Mg2＋ , Ca2＋ , pH, PaCO2, P, albumin and lactate were obtained from blood gas analysis and blood biochemistry.Based on these data, ACAG was calculated by the Henderson-hasselbalach formula and SIG was calculated by the Stewart-Figge formula.ResultsThere were significant differences in ACAG, SIG, and lactate levels between death group and survival group（P〈0.05）. The area under the ROC curve of ACAG was 0.756, and the area under the ROC curve of SIG was 0.936, which were larger than the area under the diagnostic reference line （P〈0.05）, the results were statistically significant.The sensitivity and specificity of ACAG was 79.7% and 70.0% respectively, and the cut off was 12.7.The sensitivity and specificity of SIG was 81.4% and 95.5% respectively, and the cut off was 2.7.ConclusionSIG, ACAG and lactate have the guiding value in assessing the prognosis of children with severe pneumonia.Meanwhile, SIG has a greater guiding significance for the assessment of the prognosis of children with severe pneumonia.