脓毒症患儿血清白蛋白水平与预后的相关性分析

目的 探讨脓毒症患儿血清白蛋白水平与其病情严重程度和预后的相关性。方法 回顾性收集2010年2～7月在湖南省儿童医院PICU住院诊断为脓毒症的连续病例的病史资料，提取一般情况、临床表现、实验室检查指标、疾病严重程度和预后等资料。依据入住PICU 24 h内的血清白蛋白水平分为重度低白蛋白血症组（≤25 g·L-1），中度低白蛋白血症组（～30 g·L-1），轻度低白蛋白血症组（～35 g·L-1）和正常白蛋白组（>35 g·L-1）。分析血清白蛋白水平与脓毒症患儿的临床表现、实验室指标、疾病严重程度和预后的相关性。采用Logistic回归分析血清白蛋白水平和预后的相关性。结果 符合脓毒症诊断标准的212例患儿进入分析，其中重度低白蛋白血症组24例，中度低白蛋白血症组50例，轻度低白蛋白血症组61例，正常白蛋白组77例。①重度低白蛋白血症组腹泻、腹胀、肠鸣音减弱、应激性溃疡、水肿和脏器功能衰竭数量>3个的发生率显著增高（P<0.05）。②随着血清白蛋白水平的降低， WBC计数、CRP≥8 mg·L-1和PCT＞2 mg·L-1的发生率呈升高趋势（P<0.05）；血糖≥6.7 mmol·L-1的发生率和乳酸水平呈升高趋势（P<0.05）。③随着血清白蛋白水平的降低，PRISM Ⅲ评分、严重脓毒症和脓毒性休克发生率呈升高趋势（P<0.05），PICS评分呈下降趋势（P<0.05）。④多因素Logistic回归分析结果显示，严重脓毒症和脓毒性休克、重度低白蛋白血症、PRISMⅢ评分≥8分是脓毒症患儿死亡的危险因素，OR值(95%CI)分别为8.20（1.33～18.96）、2.85（1.34～10.73）和1.22（1.02～15.78）。⑤存活患儿第1、3和7天血清白蛋白水平呈升高趋势，且显著高于死亡患儿。结论 血清白蛋白水平与炎症感染指标的相关性较好，血清白蛋白水平≤25 g·L-1可作为脓毒症患儿死亡的危险因素。

The correlation analysis of serum albumin levels and prognosis in children with sepsis

Objective To explore the association between hypoalbuminemia and the severity and prognosis of sepsis in children. Methods Children diagnosed as sepsis in PICU in Hunan Provincial Children's Hospital from February to July 2010 were retrospectively collected. Clinical manifestation, laboratory examination index, related parameters of disease severity and prognosis were extracted . According to albumin levels within 24 h admission into PICU, the patients were divided into severe hypoalbuminemia group (≤25 g·L-1), moderate hypoalbuminemia group (-30 g·L-1), mild hypoalbuminemia group (-35 g·L-1) and normal albumin group (> 35 g·L-1). The correlation of albumin levels with clinical manifestations, laboratory index and relevant outcome were analyzed. The relevance of albumin levels and the prognosis was analyzed by Logistic regression. Results A total of 212 cases meeting with sepsis criteria were analyzed, including 24 cases in severe hypoalbuminemia group, 50 in moderate hypoalbuminemia group, 61 in mild hypoalbuminemia group and 77 in normal albumin group. ① The incidences of diarrhea, abdominal distension, bowel sound weakened, stress ulcer, edema and MODS> 3 in severe hypoalbuminemia group were significantly elevated (P<0.05）. ②With the serum albumin levels decreasing , the incidences of WBC count, CRP≥8 mg·L-1 and PCT＞2 mg·L-1 , glucose ≥6.7 mmol·L-1 and lactate levels were increased(P<0.05). ③With the serum albumin levels decreasing, PRISM Ⅲ, the incidences of severe sepsis and septic shock were significantly elevated, while PICS was declined (P<0.05). ④Logistic regression analysis showed that PRISM Ⅲ≥8, severe sepsis and septic shock, severe hypoalbuminemia were death risk factors in children with sepsis , OR(95%CI) was 8.20（1.325-18.96），2.85（1.34-10.73）and 1.22（1.02-15.78） respectively. ⑤The albumin levels in survival group 1, 3 and 7 days after admission were significantly higher than the death or abandon group in the corresponding period, and there were significant differences. Conclusions Hypoalbuminemia can be used as an indirect inflammatory infection indicator to reflect the degree of severe infection. The albumin level≤25 g·L-1 can be used as the death risk factors in children with sepsis.