血清尿酸水平预测ARDS患者预后的临床观察研究-现代医学

血清尿酸水平预测ARDS患者预后的临床观察研究

单位：汉中市中心医院呼吸与危重症医学科, 陕西汉中 723000

分类号：R441.8

出版年·卷·期（页码）：2020·48·第十二期（1550-1555）

摘要：

目的： 探讨血清尿酸（SUA）水平在预测急性呼吸窘迫综合征（ARDS）患者生存预后的临床价值。方法： 回顾性分析2015年1月至2018年12月间在我院治疗的96例ARDS患者，根据入院时SUA基线水平，将患者分为SUA升高组（54例）和SUA正常组（42例），以入院后28 d和90 d死亡率为主要评价指标，比较两组患者的生存率差异和治疗预后情况，并通过Cox回归分析ARDS患者生存预后的独立危险因素。结果： 与SUA正常组比较，SUA升高组的ICU住院时间更长及总住院时间更长（均P<0.001），但28 d内无呼吸机使用时间更短（P=0.041）。SUA升高组入院后7 d内ARDS临床改善率显著低于SUA正常组（P<0.001），并且SUA升高组28 d死亡率和90 d死亡率均显著高于SUA正常组，差异有统计学意义（均P<0.05）。Kaplan-Meier生存曲线分析显示，SUA升高组总体生存期显著短于SUA正常组（P=0.007）。Cox回归模型分析显示，SUA升高（HR=2.021，95%CI：1.563~3.190，P<0.001）和氧浓度分数（FiO₂）（HR=1.542，95%CI：1.389~1.905，P<0.001）是影响ARDS患者生存期的独立危险因素。结论： SUA水平升高是预测ARDS患者死亡风险增加的有效指标。

Objective: To investigate the predictive value of serum uric acid (SUA) for the survival outcomes in patients with acute respiratory distress syndrome (ARDS). Methods: 96 patients with ARDS were retrospectively enrolled from January 2015 to December 2018, anddivided into SUA-elevated group (54 cases) and SUA-normal group (42 cases) according to the baseline SUA levels. The 28-day and 90-day mortality rates after hospitalized were set as the main evaluated indicators, and the survival and therapeutic prognosis in the two groups were compared. The independent risk factors for predicting the survival prognosis of ARDS patients were analysedby Cox regression. Results: Compared with the SUA-normal group, the SUA-elevated group had longer ICU hospitalization days (P<0.001), longer total hospitalization days (P<0.001), but shorter ventilator-free days within 28 days after admission (P=0.041). Compared to the SUA-normal group,the SUA-elevated group had lower ARDS improvement rate, but higher 28-day mortality rate and higher 90-day mortality rate(all P<0.05). Kaplan-Meier curve showed that the overall survival of the SUA-elevated group was significantly poor than that of the SUA-normal group (P=0.007). Cox regression analysis showed that elevated SUA level (HR=2.021, 95% CI:1.563~3.190, P<0.001) and fraction of inspiration(FiO₂) (HR=1.542, 95% CI:1.389-1.905, P<0.001) were independent risk factors for predicting poor survivals in patients with ARDS.Conclusion: Elevated level of SUA is an effective biomarker for predicting the increased risk of death in patients with ARDS.

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