ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2022, Vol. 31 ›› Issue (3): 217-222.DOI: 10.3969/j.issn.1006-298X.2022.03.003

• • 上一篇    下一篇

血液有形成分容积指标变化与危重患者容量及预后的相关性研究

  

  • 出版日期:2022-06-28 发布日期:2022-06-27

Volume index change of blood formed elements with body volume and prognosis in critically ill patients

  • Online:2022-06-28 Published:2022-06-27

摘要:

目的:分析危重患者血常规容积相关指标包括红细胞比容(HCT)及平均血小板体积(MPV)短期内变化率与基于生物电阻抗法(BIA)的容量指标变化的相关性,以及对预后的影响。
方法:筛选2020年11月至2021年5月东部战区总医院重症监护病房(ICU)的危重患者,入院当天和第3天进行BIA测量并记录总体水(TBW)、细胞外水(ECW)、细胞内水(ICW)等指标,收集两次测量当天血细胞体积相关指标。以生物电阻抗矢量分析图(BIVA)进行容量分组。使用双变量相关性分析BIA容量指标变化率与血细胞体积变化率的相关性。以变化率数值的四分之一位数和四分之三位数为界限分三组,以90 d死亡为终点,进行不同分组以及联合赋分的预后分析。 
结果:共入选198例患者,其中男性137例,高容量132例,90 d累积死亡率为308%。HCT、血小板比容(PCT)变化率与TBW、ECW及ICW有较低相关性,在非高容量组中相关系数更高。依据HCT以及MPV变化率分组后绘制KaplanMeier生存曲线提示累计生存差异明显,上升组死亡率最高。进行联合赋分后总体死亡率均与赋分分值呈显著线性相关(预测公式分别为Y=0102X+0156,R2=0931,P=0008),COX多因素回归分析提示,联合赋分值是危重患者90 d死亡独立危险因素(HR 1322,95%CI 1068~1637,P=0010)。 
结论:HCT、PCT、MPV的动态变化与BIA容量指标变化具有相关性;HCT及MPV短期内较基线出现较大波动(尤其是上升)可能与危重患者不良预后相关,联合两者的变化率的赋分是预测患者90 d死亡的独立危险因素。

Abstract: Objective:To investigate association of shortterm change of hematocrit (HCT) ,mean platelet volume (MPV) with variation of volume status evaluated by bioimpedance analysis (BIA) in critically ill patients and their outcome.
Methodology:Patients admitted to intensive care unit(ICU) of Jinling hospital from November 2020 to May 2021 were screened for enrollment. Patients with repeated measurements of BIA on the first and the third day of admission were enrolled, the total body water (TBW), extracellular water (ECW), intracellular water (ICW) obtained from BIA measurements were collected,and blood cell volume related indicators were collected. Bioelectrical impedance vector analysis (BIVA) was used for capacity grouping. The correlation between change rate of BIA volume index with change rate of blood cell volume were performed. The patients were divided into three groups according to the quartile and three quartile of the change rate. The prognosis of different group and combined scoring were anglyed with 90 days death as the end point.
Results:A total of 198 patients were selected, including 137 males and 132 highvolume patients. The 90day mortality rate was 308%.The change rates of HCT and PCT had a low correlation with TBW, ECW and ICW, and the correlation coefficients were higher in the nonhigh volume group. KaplanMeier survival analysis showed a significant difference of survival rate between groups divided by change rate of HCT and MPV. The increased group had the highest death rate. A combination score integrated the change rate of HCT and MPV was found significantly linearly correlated with the overall mortality and the mortality (prediction equation: Y=0102X+0156,R2=0931,P=0008). COX multivariate regression analysis showed that the combination score was an independent risk factor for 90day mortality (HR 1322,95%CI 1068~1637,P=0010).
Conclusion:The dynamic changes of HCT, PCT and MPV have a certain correlation with the changes of BIA capacity index;Greater shortterm fluctuation of HCT and MPV (especially uprise) was correlated with the poor prognosis in critically ill patients; The combination score integrated the change rate of HCT and MPV is an independent risk factor for predicting the 90day mortality.