动态监测尿微量蛋白对危重患者预后的价值

目的 探讨尿微量蛋白作为危重患者预后指标的可行性。 方法 前瞻性动态监测ICU危重患者尿微量白蛋白(MA)、α1-微球蛋白(α1-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)，并与目前临床常用的预后评估系统APACHEⅡ、SOFA进行比较。结果 相关分析结果显示尿MA、α1-MG、NAG、住ICU时间、机械通气时间、APACHEⅡ评分、SOFA与死亡呈正相关。尿MA、α1-MG、住ICU时间、机械通气时间、APACHEⅡ评分、SOFA升高与多器官功能不全综合征(MODS)发生呈正相关。尿MA(r=0.397)、α1-MG(r=0.448)和RBP(r=0.465)与APACHEⅡ评分显著相关。APACHEⅡ评分、SOFA评分、MA、α1-MG、RBP、NAG预测死亡的ROC曲线下面积分别是0.875﹙P < 0.05﹚、0.825﹙P < 0.05﹚、0.820﹙P < 0.05﹚、0.730、0.530、0.620。结论 动态监测尿MA、α1-MG、RBP可作为危重患者预后的临床指标。

Clinical study of urinary microprotein as predictors of outcome in critically ill patients

Objective To evaluate the feacibility of microalbumin(MA)，alpha-1-microglobulin(α1-MG)，N-acetyl-beta-D-glucosaminidase(NAG)，retinol-binding protein(RBP)as predictors of outcome in critically ill patients. Methods A prospective study was underwent in 30 critically ill patients.Urinary samples were collected at ICU admission and on the third，seventh ICU day for MA，α1-MG，NAG，RBP measurement.The severity of illness was assessed by APACHEⅡ score calculated on the first ICU day，and the degree of organ dysfunction was assessed using SOFA score calculated on the first，third，seventh ICU day. Results MA，α1-MG，the durations of ICU stay and mechanical ventilation，APACHEⅡscore， SOFA score were relative factors of MODS and death in ICU. There was significant association of APACHEⅡ with MA(r=0.397)， α1-MG(r=0.448)， and RBP(r=0.465)， respectively. The area under ROC curve of APACHEⅡ score，SOFA score，MA，α1-MG，RBP，NAG to predicate the death in ICU were 0.875﹙P < 0.05﹚，0.825﹙P < 0.05﹚， 0.820﹙P < 0.05﹚，0.730，0.530，0.620. Conclusion MA，α1-MG and RBP are valuable predictors of outcome in critically ill patients.