血乳酸与血清清蛋白比值对新生儿脓毒性休克的早期预测价值

Early predictive value of lactate/albumin ratio in neonatal infants with septic shock

目的探讨血乳酸与血清清蛋白比值对新生儿脓毒性休克的早期预测价值。方法回顾性研究2017年1月至12月广东省妇幼保健院新生儿科收治的脓毒症患儿185例。按照诊断脓毒症24 h内的血乳酸与血清清蛋白比值(lactate/albumin ratio,L/A)水平分为低L/A水平组(L/A<0.1)、中L/A水平组(0.1≤L/A<0.2)和高L/A水平组(L/A≥0.2)。比较各组患儿临床特征、相关实验室指标及预后,多因素Logistic回归分析影响新生儿脓毒性休克的相关因素,采用受试者工作特征曲线分析相关指标对新生儿脓毒性休克的早期预测价值。结果共纳入新生儿脓毒症185例,其中低L/A水平组88例、中L/A水平组64例、高L/A水平组33例。各组新生儿性别、胎龄、出生体质量、1 min及5 min Apgar评分、小于胎龄儿与使用肺表面活性物质差异均无统计学意义(均P>0.05),母亲孕期子痫、妊娠期糖尿病、发热与分娩时羊水Ⅲ度浑浊各组差异均无统计学意义(均P>0.05);各组C反应蛋白、白细胞计数、中性粒细胞计数及比例、淋巴细胞计数及比例、血小板计数差异均无统计学意义(均P>0.05);高L/A水平组剖宫产率、降钙素原、血乳酸和Ⅲ级及以上颅内出血、脑白质软化、多器官功能障碍症、弥散性血管内凝血、脓毒性休克、死亡的发生率高于中、低L/A水平组,差异均有统计学意义(均P<0.05);低L/A水平组母亲胎膜早破时间>24 h的发生率、血清清蛋白、pH值及剩余碱高于中、高L/A水平组,差异均有统计学意义(均P<0.05);多因素Logistic回归分析显示,低清蛋白血症、高乳酸血症、酸碱度下降、L/A≥0.1是脓毒性休克的独立危险因素。诊断新生儿脓毒症24 h内L/A>0.114与脓毒症并发脓毒性休克相关,敏感度为76.90%,特异度为81.30%。结论诊断新生儿脓毒症24 h内L/A升高可作为预测新生儿脓毒性休克的独立危险因素。

Objective To analyze the predictive value of lactate/albumin(L/A)ratio in neonatal infants with septic shock.Methods The data of 185 neonatal infants with sepsis from January to December 2017 were retrospective analyzed in Guangdong Women and Children Hospital.The data were divided into low level of L/A group(L/A<0.1),medium level of L/A group(0.1≤L/A<0.2)and high level of L/A group(L/A≥0.2)according to L/A ratio level within 24 hours of sepsis.The clinical features,related laboratory indications and prognosis among the 3 groups were compared.Multivariate Logistic regression was used to analyze the effects of various factors on the occurrence of neonatal septic shock.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the early predictive va-lue of related indicators for neonatal septic shock.Results A total of 185 neonatal infants with sepsis were collected.There were 88 cases in low level of L/A group,64 cases in medium level of L/A group and 33 cases in high level of L/A group.There were no significant difference in gender,gestational age,birth weight,1 and 5-minute Apgar scores,small for gestational age,use of pulmonary surfactant,maternal preeclampsia,gestational diabetes mellitus,maternal fever and severe meconium stained(all P>0.05).There were no statistical differences among three groups in C-reactive protein,white blood cell count,neutrophil count and proportion,leucine count and proportion and platelet count(all P>0.05).Compared with low and medium level of L/A groups,the high level of L/A group had higher proportion of cesarean section,higher procalcitonin and lactate,severe intracranial hemorrhage,periventricular leucomalacia,multiple organ dysfunction syndrome,disseminated intravascular coagulation,septic shock and the dead;low level of L/A group had higher proportion of maternal premature rupture of membranes>24 hours,albumin,pH or base excess(BE),and there were statistically significant differences in all of those(all P<0.05).Multivariate Logistic regression analysis showed that hypoalbuminemia,hyperlacticemia,decreased pH and L/A≥0.1 were independent predictors for neonatal septic shock.L/A more than 0.114 within 24 hours was associated with neonatal septic shock,with a sensitivity of 76.90%and specificity of 81.30%.Conclusions The increased of L/A within 24 hours of sepsis can be used as an independent risk factor for predicting septic shock in neonatal infants.