重症患者血清视黄醇结合蛋白变化与预后的相关性研究

目的通过分析血清视黄醇结合蛋白（RBP）水平动态变化与预后的关系,探讨重症患者营养状况对预后的影响作用。方法重症患者90例,按28 d生存率分为存活组和死亡组,入选患者记录入ICU第1、3、7天血清RBP值及APACHEⅡ评分;比较2组患者同时点RBP值与APACHEⅡ评分,进行死亡率与各时点RBP水平及ACAHEⅡ评分相关及回归分析。结果①死亡组入科3、7天RBP水平均低于存活组（P〈0.05）;死亡组入科第1、3、7天APACHEⅡ评分均高于存活组（P〈0.05）。2组患者入科当日RBP水平差异无统计学意义（P〉0.05）。②死亡率与入科第3、7天RBP水平呈负相关（P〈0.05）,与入科第1、3、7天APACHEⅡ评分呈正相关（P〈0.05）;与入科当日RBP水平无相关关系（P〉0.05）;③以住院死亡率为因变量的Logistic回归分析显示,入科第3、7d RBP与预后密切相关（OR分别为14.132、3.957,P值分别为0.000、0.047）。结论重症患者的营养状况影响预后,应动态监测营养指标,合理营养,以减少死亡率。

Relationship between changes in serum retinal- binding protein level and prognosis in critically ill patients

Objective To analyze the correlation of changes in serum retinal binding protein（ RBP） level and their prognosis in critically ill patients,and investigate the impact of nutrition on prognosis in critically ill patients. Methods 90 severe cases were divided into the survival group and death group according to 28 Day＇s survival rate. Blood RBP and APACHEⅡ were measured at the first day, the third day and the seventh day among all cases,RBP level and APACHEⅡ score were compared separately at the same time point between the two groups,then the relationship and regression analysis were performed between the death rate and RBP,and APACHEⅡ on each time point. Results RBP level was lower in the nonsurvivors than survivors on the third day and the seventh day（ P 0. 05）. A- PACHEⅡ scores in the nonsurvivors were higher than survivors throughout the ICU course（ P 0. 05）,but there was no difference in RBP at admission between the two groups. Dead rate was negatively with RBP level at the third day and the seventh day（ P 0. 05）, positively with APACHEⅡ scores throughout the ICU course（ P 0. 05）,irrelevantly with RBP at admission（ P 0. 05）. Logistic regression analysis with hospital mortality was as dependent variable,RBP level on the third and the seventh day was still significantly related with hospital mortality of critically ill patients（ OR = 14. 132,3. 957; P = 0. 000,0. 047）. Conclusion Nutritional status of patients can impact on prognosis in critically ill patients,and the nutritional therapy is expected to improve prognosis of critically ill patients.