【摘要】 目的 探讨尿感染性休克患者血清C反应蛋白（CRP）、白蛋白（ALB）比值（CRP/ALB）对预测7 d急性呼吸窘迫综合征（ARDS）的临床价值。方法 回顾性分析我院ICU 2010-09-01～2013-08-31尿感染性休克患者53例。患者于入ICU后采外周静脉血,检测全血常规、CRP、ALB,前7 d每天进行急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）和脓毒症相关的脏器衰竭评分（SOFA）,根据7 d内是否合并ARDS分成尿感染性休克组和ARDS组。比较两组入选时CRP、ALB和CRP/ALB,第7天氧合指数（PaO₂/FiO₂）、APACHEⅡ评分和SOFA评分,Spearman秩相关分析入选时CRP/ALB与第7天PaO₂/FiO₂、APACHEⅡ评分、SOFA评分的关系,受试者工作特征（ROC）曲线下面积法检验入选时CRP/ALB的预测效力。结果 ARDS组与尿感染性休克组患者入选时血清CRP、ALB浓度比较差异无统计学意义（P均>005）,但ARDS组CRP/ALB显著高于存活组（P<0.05）;第7天ARDS组PaO₂/FiO₂显著低于尿感染性休克组,APACHE I评分和SOFA评分显著高于尿感染性休克组（P均<0.05）。入选时CRP/ALB与第7天PaO₂/FiO₂呈显著负相关,与APACHEⅡ评分和SOFA评分呈显著正相关（P均<0.05）;预测7d内是否合并ARDS的ROC曲线下面积0.677±0.091（P=0.046,95%C1 0.499～0.855）,最佳截断点2.42,此时敏感度为73.3%,特异度57.9%。结论 CRP/ALB可预测尿感染性休克即将发生的ARDS,其对于评估毛细血管渗漏、指导液体复苏和预后预测等可能是一个有用的工具,值得进一步研究探讨。更多还原

【Abstract】 Objective To investigate the clinical value of the ratio of C- reactive protein to albumin for predicting acute respiratory distresssyndrome（ARDS） in patients with uroseptic shock.Methods In our Intensive Care Unit,from September 1,2010 to August 31,2013,62 urosepsis shock patients were included in this retrospective study.Finally,53 patients were included in the further analysis.Peripheral blood samples were collected on days 0 and serum C- reactive protein（CRP）,albumin（ALB） levels were measured.SOFA scores and APACHE II scores were recorded everyday for7 days.Patients’ prognoses were assessed during the 7- day follow- up period.According to the occurrence of ARDS or not within the 7- day period,the patients were divided into uroseptic group and ARDS group.Serum CRP,ALB levels and the ratio of C- reactive protein to albumin（CRP/ALB） on days 0,PaO₂/FiO₂,APACHE Ⅱ scores and SOFA scores on day 7,were compared by Student′s t- test between the two groups.Spearman rank correlation was used to analyze the correlation between CRP/ALB on day 0 and PaO₂/FiO₂,APACHE II scores as well as SOFA scores on day 7.The effect on predicting ARDS within the 7- day period in CRP/ALB was evaluated by receiver operating characteristic curves（ROC curves）.Results There was no significant difference in serum CRP,ALB levels on day 0 between the uroseptic group and ARDS group（P > 0.05）.The CRP/ALB of ARDS group was significantly higher than that of uroseptic group on day 0,and PaO₂/FiO₂ of ARDS group was significantly lower,APACHE II scores were significantly higher as well as SOFA scores on day 7 than those of uroseptic group（P <0.05）.The CRP/ALB on day 0 was significantly negative correlative with PaO₂/FiO₂ on day 7,positively correlative with APACHE Ⅱ scores as well as SOFA scores on day 7（P < 0.05）.ROC curves area of the CRP/ALB was 0.677 ± 0.091（P = 0.046,95%CI 0.499 ～0.855）for predicting 7- day ARDS.The optimal cut- off point was 2.42,and the sensitivity and specificity were 73.3%and 57.9%at this time,respectively.Conclusion The CRP/ALB can be served as one of the indicators to predict 7- day ARDS,it may be a useful tool for assessment of the capillary leakage,guiding fluid resuscitation and prognosis prediction in patients with uroseptic shock.Further study is worthwhile in this field.更多还原