微量白蛋白尿预测SICU术后患者预后价值.doc

微量白蛋白尿预测SICU术后患者预后价值 　 作者：王燕婷，皋源，王祥瑞，杭燕南 【摘要】 目的 观察外科监护室(surgical intensive care unit, SICU)患者微量白蛋白尿(microalbuminuria, MAU)水平术前和术后的变化，探讨MAU水平与APACHEⅡ评分的关系，比较两者预测SICU术后患者预后的价值。方法 留取100例收入SICU患者的术前及术后6h的尿液标本，测定尿白蛋白含量和尿肌酐。分别以尿白蛋白排泄率(urine albumin excretion rate, UAER)或尿白蛋白/尿肌酐比值(microalbuminuia/urinary creatinine ratio, MACR)来评价MAU水平。所有研究对象均在术后入SICU 24h后进行APACHEⅡ评分。结果 SICU术后患者MAU水平较术前明显增高。UAER、MACR均与APACHEⅡ评分呈显著正相关(r=0.218，Plt;0.05；r=0.461，Plt;0.01)。100例研究对象中，死亡5例，存活95例。死亡组无论是UAER、MACR，还是APACHEⅡ评分，均明显高于存活组(P均lt;0.05)。UAER、MACR及APACHEⅡ评分在对SICU术后患者死亡预测的受试者工作特性曲线下所占面积(area under receiver operating characteristic curve, AUROC)分别为0.773、0.918和0.941。当以MACRgt;14.8mg/mmol为分界时，敏感性为100%，特异性为77%。结论 SICU术后患者MAU水平与APACHEⅡ评分呈显著正相关，可以用来评价疾病严重程度并预测预后。术后患者MACR阈值取14.8mg/mmoL可同时获得较高的敏感性和特异性。 【关键词】 微量白蛋白尿；APACHEⅡ评分；外科监护室；预后预测 　　Prognosis predictive value of microalbuminuria　in postoperative patients in SICU 　　ABSTRACT: Objective To investigate the perioperative prevalence of microalbuminuria(MAU) and the relationship between MAU and APACHEⅡ score in postoperative patients admitted to a surgical intensive care unit (SICU) and to compare the predictive value of MAU and APACHEⅡ score for the prognosis. Methods Urine samples were collected before operation and 6 hours after admission to the SICU to determine urine albumin and urinary creatinine for assessment of MAU in 100 postoperative patients. MAU was expressed as urine albumin excretion rate (UAER) or microalbuminuia/urinary creatinine ratio (MACR). APACHEⅡ score was calculated from the data collected 24h after SICU admission. Results The level of MAU in the postoperative patients was higher than that before operation. Both UAER and MACR had a positive correlation with APACHEⅡ score (r=0.218, Plt;0.05; r=0.461, Plt;0.01). For the 100 postoperative patients, 95 of them survived and 5 did not. UAER, MACR and APACHEⅡ score in the nonsurvivors were all significantly higher than those in the survivors (Plt;0.05). The area under receiver opera