摘要
目的探究高原性肺水肿(HAPE)高压氧(HBO)治疗前后血清乳酸(LAC)水平变化及其与预后相关性。方法选取2020年6月至2023年6月于温州市人民医院住院接受HBO治疗的HAPE患者165例为研究对象,对其一般资料、血常规参数、血生化检验、肝肾功能、凝血功能指标、炎症因子水平等相关临床数据进行统计。根据疗效评定标准评估患者的预后情况,将疗效表现为治愈与显效的患者划分为预后良好组(n=118),疗效表现为有效与无效的患者分为预后不良组(n=47)。采用logistic回归分析LAC与HAPE患者HBO治疗预后的关系。对LAC与HAPE患者HBO治疗预后不良风险相关性进行亚组分析。采用局部加权回归散点平滑法(LOWESS)分析连续变量二维曲线关系。对脑微循环血流与血管生长因子进行交互作用分析。应用限制性立方样条法分析脑微循环血流与预后不良的剂量反应关系。最后对脑微循环血流进行决策曲线分析(DCA)。结果与HBO治疗前相比,经治疗后的HAPE患者在心率、呼吸次数、动脉血氧饱和度、动脉血二氧化碳分压、动脉血氧分压、白蛋白(Alb)、球蛋白(Glb)、红细胞计数、LAC、乳酸脱氢酶(LDH)、血尿酸、尿液尿酸、血清天冬氨酸氨基转移酶(AST)、α羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)方面的差异具有统计学意义(P<0.05)。经HBO治疗的HAPE患者中,预后不良组患者Alb、Glb、LAC、LDH、AST、α-HBDH、CK的指标水平均显著高于预后良好组(P<0.05)。多因素logistic回归分析显示,LAC、LDH、Alb、α-HBDH、CK是HAPE患者预后不良发生的独立影响因素(P<0.05)。在Alb、LDH、α-HBDH、CK亚组中,LAC与HAPE患者HBO治疗预后不良风险的相关性稳定存在,亚组间不存在交互作用(P_(交互)>0.05)。LOWESS分析显示,Alb、LDH、α-HBDH、CK与LAC均具有一定的非线性关系,LAC与Alb、LDH、α-HBDH、CK呈正相关(P<0.05)。限制性立方样条法分析表明,LAC连续变化与预后不良呈非线性剂量反应关系,LAC与预后不良大致呈正相关(P<0.05);当LAC大于截断值1.56 mmol/L时,随着LAC水平增加,患者预后不良的风险显著上升。DCA显示LAC对患者预后的预测有重要临床价值。结论高水平LAC是影响HAPE患者预后不良的独立影响因素,与预后不良呈正相关关系,该指标可能有助于评估HAPE患者的预后情况。
Objective To explore the changes of serum lactic acid(LAC)level before and after hyperbaric oxygen(HBO)treatment in high-altitude pulmonary edema(HAPE)and its correlation with prognosis.Methods In this study,165 HAPE patients who received HBO treatment in Wenzhou People s Hospital from June 2020 to June 2023 were selected,and general data,blood routine parameters,blood biochemical tests,liver and kidney function,coagulation function indexes,inflammatory factor levels and other related clinical data of the subjects were statistically analyzed.According to the evaluation criteria of efficacy,patients with curative effect were divided into good prognosis group(n=118),and patients with effective and ineffective efficacy were divided into poor prognosis group(n=47).Logistic regression was used to analyze the relationship between LAC and prognosis of HBO treatment in HAPE patients.Subgroup analysis was performed to analyze the correlation between LAC and the risk of poor prognosis after HBO treatment in HAPE patients.Locally weighted scatterplot smoothing(LOWESS)was used to analyze the two-dimensional curve relationship of continuous variables.The interaction between blood flow in cerebral microcirculation and vascular growth factor was analyzed.The dose-response relationship between blood flow in cerebral microcirculation and poor prognosis was analyzed by restricted cubic splines.Finally,decision curve analysis(DCA)of blood flow in cerebral microcirculation was performed.Results Compared with before HBO treatment,there were statistically significant differences in heart rate,respiratory frequency,arterial oxygen saturation,arterial partial pressure of carbon dioxide,arterial partial pressure of oxygen,albumin(Alb),globulin(Glb),red blood cell count,LAC,lactate dehydrogenase(LDH),blood uric acid,urine uric acid,serum aspartate aminotransferase(AST),α-hydroxybutyrate dehydrogenase(α-HBDH),and creatine kinase(CK)in HAPE patients after treatment(P<0.05).Among the HAPE patients treated with HBO,the indexes of Alb,Glb,LAC,LDH,AST,α-HBDH and CK in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).Multivariate logistic regression analysis showed that LAC,LDH,Alb,α-HBDH and CK were independent influencing factors of poor prognosis in HAPE patients(P<0.05).In the Alb,LDH,α-HBDH and CK subgroups,there was a stable correlation between LAC and the risk of poor prognosis after HBO treatment in HAPE patients,and there was no interaction between subgroups(P_( interaction)>0.05).LOWESS analysis showed that Alb,LDH,α-HBDH,CK and LAC all had a certain nonlinear relationship,and LAC was positively correlated with Alb,LDH,α-HBDH and CK(P<0.05).Restricted cubic spline analysis showed that the continuous change of LAC was correlated with poor prognosis in a nonlinear dose-response manner,and LAC was positively correlated with poor prognosis(P<0.05).When LAC was greater than the cutoff value of 1.56 mmol/L,the risk of poor prognosis increased significantly with the increase of LAC level.DCA showed that LAC had important clinical value in predicting the prognosis of patients.Conclusion High-level LAC is an independent factor affecting the poor prognosis of HAPE patients,and it is positively correlated with poor prognosis.This index may be helpful to evaluate the prognosis of HAPE patients.
作者
汤程远
TANG Chengyuan(The Third Affiliated Hospital of Shanghai University/Wenzhou People s Hospital,Wenzhou 325000,China)
出处
《空军军医大学学报》
2025年第6期746-754,共9页
Journal of Air Force Medical University
基金
浙江省医药卫生科技计划项目(2020KY657)。
关键词
高原性肺水肿
高压氧
血清乳酸
预后
high-altitude pulmonary edema
hyperbaric oxygen
serum lactic acid
prognosis
