摘要
目的 探讨脓毒症患者相位角及血清前白蛋白在营养状况评估中的价值及其与临床预后的关系.方法 回顾性选取2022年8月至2023年8月邢台市中心医院收治的110例脓毒症患者进行研究,参照Kyle标准、《外科学》标准分别将患者分为正常相位角组(n=38)、低相位角组(n=72)和正常前白蛋白组(n=40)和低前白蛋白组(n=70),另根据患者的短期预后情况将其分为生存组(n=82)和死亡组(n=28).比较正常相位角组与低相位角组和正常前白蛋白组与低前白蛋白组的一般资料、疾病相关评分和常规营养指标;建立多因素Logistic模型,分析影响脓毒症患者营养状态和预后的独立危险因素;比较不同预后患者相位角、血清前白蛋白水平;采用双变量Spearman相关性检验分析相位角、前白蛋白与营养不良和不良预后的相关性,并计算其预测价值.结果 与正常相位角组、正常前白蛋白组比较,低相位角组、低前白蛋白组的血红蛋白、白蛋白、上臂围度、上臂肌肉维度、骨骼肌量、体细胞量、去脂体重、肌肉量均较低,营养风险筛查2002(NRS2002)评分≥3分、患者主观整体评估量表(PG-SGA)评分(4～8分、≥9分)的患者均较高,差异均有统计学意义(P＜0.05).多因素Logistic分析,结果显示,血红蛋白、白蛋白、NRS2002评分、PG-SGA评分、上臂围度、上臂肌肉维度、骨骼肌量、体细胞量、去脂体重、肌肉量、相位角、前白蛋白均是影响脓毒症患者营养状态的影响因素(P＜0.05).与存活组比较,死亡组相位角值、前白蛋白水平较低,差异均有统计学意义(P＜0.05).相位角、前白蛋白与营养不良、不良预后均呈负相关(P＜0.05).相位角、前白蛋白、相位角+前白蛋白对脓毒症营养不良、不良预后预测的AUC值均＞0.75,预测价值较高,相位角+前白蛋白预测价值最高.结论 相位角值和前白蛋白水平越低,脓毒症患者营养风险和不良预后风险越高,监测相位角和前白蛋白有利于判断脓毒症患者的营养状态及预后..
Abstract
Objective To investigate the value of phase angle and serum prealbumin in the evaluation of nutritional status in patients with sepsis and their relationship with clinical prognosis.Methods This study was a retrospective analysis,110 patients with sepsis admitted to Xing-tai Central Hospital from August 2022 to August 2023 were selected for study.According to Kyle standard and"surgical"standard,the patients were divided into the normal phase angle group(n=38),the low phase angle group(n=72)and the normal prealbumin group(n=40)and the low prealbumin group(n=70).According to the short term prognosis of the patients,they were divided into the survival group(n=82)and the death group(n=28).The general data,disease-related scores and routine nutritional indicators of normal phase angle group and low phase angle group and normal prealbumin group and low prealbumin group were compared.Multivariate Logistic model were established to analyze the independent risk factors affecting the nutritional status and prognosis of patients with sepsis.The levels of phase angle and serum prealbumin in patients with different prognosis were compared.The correlation between phase angle,prealbumin and malnutrition and poor prognosis were ana-lyzed by bivariate Spearman correlation test,and its predictive value was calculated.Results Compared with the normal phase angle group and the normal prealbumin group,the low phase angle group and the low prealbumin group had lower hemoglobin,albumin,upper arm circumference,upper arm muscle dimension,skeletal muscle mass,somatic cell mass,fat-free weight,and muscle mass.Patients with nutritional risk screening 2002(NRS2002)score ≥3 points and patient subjective global assessment scale(PG-SGA)score(4-8 points,≥9 points)were higher(P＜0.05).Multivariate Logistic analysis showed that NRS2002,hemoglobin,ALB,PG-SGA,upper arm circumference,upper arm muscle dimen-sion,skeletal muscle mass,somatic cell mass,fat-free weight,muscle mass,phase angle and prealbumin were influence factors affecting the nu-tritional status of patients with sepsis(P＜0.05).Compared with the survival group,the phase angle value and prealbumin level in the death group were lower(P＜0.05).Phase angle and prealbumin were negatively correlated with malnutrition and poor prognosis(P＜0.05).The AUC value of phase angle,prealbumin and phase angle+prealbumin was＞0.75,with high predictive value,and the highest predictive value of phase angle+prealbumin.Conclusion The lower the phase angle value and prealbumin level,the higher the nutritional risk and poor prognosis risk of sepsis patients.Monitoring phase angle and prealbumin are helpful to judge the nutritional status and prognosis of sepsis patients.
维普
万方数据