| 创伤患者早期尿微量白蛋白水平与创伤严重程度关系的研究 |
| 投稿时间：2016-12-30 修订日期：2017-01-05 点此下载全文 |
| 引用本文：冯坤,赵钢,吴蔚,叶珏明,李梅芳,谢申琦,杨开超,仲伟喜,朱晓光,封启明.创伤患者早期尿微量白蛋白水平与创伤严重程度关系的研究[J].医学研究杂志,2017,46(9):38-41 |
| DOI：
10.11969/j.issn.1673-548X.2017.09.011 |
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| 基金项目:国家临床重点专科建设基金资助项目（2013-544） |
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| 中文摘要:目的 探讨创伤患者尿微量白蛋白（microalbuminuria，MAU）水平的早期动态改变及与创伤严重程度的关系。方法 收集急诊重症病房132例创伤患者，留取创伤后第24、48、72h内的晨尿标本，采用免疫比浊法测定尿微量白蛋白，结果以尿白蛋白/肌酐比值（urinary albumin/creatinine ratio，UACR）表示。按入院后创伤严重程度评分（ISS）分为3组，即轻度创伤组（48例，ISS<16分），中度创伤组（44例，16≤ISS≤25分）和重度创伤组（40例，ISS>25分），比较3组患者不同时段的UACR水平，分析早期UACR水平与创伤严重程度的关系。结果 （1）随着创伤严重程度的增加，创伤患者的血白细胞计数、中性粒细胞比例及CRP明显增高、血浆白蛋白明显减少、住院天数显著延长（P<0.05）。（2）3组患者UACR水平在入院后24h内达到高峰，随后开始下降，中度和重度创伤组在各时段UACR水平较轻度创伤组明显升高（P<0.05）。（3）多元Logistic回归分析显示，在控制其他危险因素后，创伤后早期UACR水平是创伤严重程度的一个重要预测因子[中度创伤组：危险度（OR）=1.106；95% CI：1.055~1.159，P=0.000；重度创伤组：危险度（OR）=1.140；95% CI：1.084~1.198，P=0.000]。结论 创伤患者早期UACR水平明显升高，可以作为判断创伤严重程度的早期有效指标之一。 |
| 中文关键词:创伤 微量白蛋白 尿白蛋白/肌酐比值 创伤严重程度 |
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| Study of Association between Microalbuminuria and Injury Severity in Trauma Patients at the Early Stage |
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| Abstract:Objective To study the dynamic changes of microalbuminuria and to investigate the correlations between microalbuminuria level and injury severity in trauma patients at the early stage. Methods A total of 132 trauma patients were enrolled from emergency intensive care unit. We collected their morning urine samples within 24, 48 and 72 hours after trauma respectively and then microalbuminuria was measured by turbidimetric immunoassay and expressed by UACR. Secondly, these patients were divided into 3 groups according to the injury severity score(ISS):the slight group(ISS<16), moderate group(16 ≤ ISS ≤ 25) and severe group (ISS>25). Then we contrast the UACR levels at each period among three groups andanalyze the relationship between UACR and injury severity. Results (1) As the increasing degree of injury, the patients with significantly higher blood white blood cell count, neutrophil percentage, CRP and lower serum albumin and longer days of hospitalization(P<0.05).(2) The UACR levels in each group rose to the peak within 24 hours after admission and then began to reduce. The levels of UACR in the moderate and severe groups were remarkably higher than that in the slight group (P<0.05). (3)Multivariate logistic analysis showed that the UACR levels was still significant predictors for injury severity (moderate group:OR=1.106, 95% confidence interval:1.055-1.159,P=0.000; severe group:OR=1.140, 95% confidence interval:1.084-1.198,P=0.000) even after controlling other risk factors. Conclusion UACR increased significantly in early trauma patients. It can be used as the early effective indicator to evaluate the severity of injury. |
| keywords:Trauma Microalbuminuria Urinary albumin/creatinine ratio Injury severe score |
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