脐血白蛋白对超低出生体重儿死亡的预测价值

Predictive value of cord blood albumin for mortality in extremely low birth weight infants

摘要

目的 探讨脐血白蛋白(ALB)对超低出生体重儿(ELBW)死亡的预测价值,为早期识别高危患儿及优化临床干预策略提供科学依据。方法 采用回顾性分析,选取2019年11月—2024年6月收治的106例生后1h内即转入沧州市人民医院新生儿重症监护病房(NICU)的ELBW为研究对象。根据住院期间是否存活,分为存活组(n=75)与死亡组(n=31)。收集两组患儿的一般临床资料及脐血生化指标数据。采用多因素logistic回归分析脐血ALB对ELBW死亡风险的影响,绘制受试者工作特征曲线(ROC)评估死亡风险。结果 两组患儿在胎龄(Z=4.108)、出生体重(Z=3.162)、1min Apgar评分(Z=3.752)、5min Apgar评分(Z=3.304)、胎膜早破≥18h(χ²=5.533)、窒息比例(χ²=26.424)、母孕期高血压比例(χ²=12.273)、剖宫产比例(χ²=6.870)方面差异有统计学意义(P＜0.05)。死亡组患儿脐血ALB(t=4.553)、球蛋白水平(t=2.784)低于存活组,差异有统计学意义(P＜0.01)。多因素logistic回归分析结果表明,脐血ALB是ELBW死亡的独立保护因素(OR=0.742,95%CI:0.574~0.995,P<0.05)。ROC分析显示脐血ALB的最佳截止值为28.5g/L。结论 脐血ALB水平对ELBW死亡具有良好的预测价值,可作为早期评估预后的重要指标,为临床早期干预提供参考依据。

Abstract

Objective To investigate the predictive value of cord blood albumin (ALB) for mortality in extremely low birth weight infants (ELBW), so as to provide a scientific basis for early identification of high-risk infants and optimization of clinical intervention strategies. Methods A retrospective cohort study was conducted on 106 ELBW infants admitted to the neonatal intensive care unit (NICU) of Cangzhou People's Hospital within 1 hour after birth from November 2019 to June 2024.Infants were divided into a survival group (n=75) and a death group (n=31) based on in-hospital outcomes.General clinical data and postnatal cord blood biochemical parameters were collected and compared between the two groups.Multivariate logistic regression analysis was employed to assess the impact of ALB on mortality risk in ELBW infants, and receiver operating characteristic (ROC) curves were plotted to evaluate the mortality risk. Results Significant differences were observed between the two groups in gestational age (Z=4.108), birth weight (Z=3.162), 1-minute Apgar score (Z=3.752), 5-minute Apgar score (Z=3.304), premature rupture of membranes ≥18 hours (χ²=5.533), asphyxia (χ²=26.424), maternal gestational hypertension (χ²=12.273) and profortion of cesarean section (χ²=6.870) (P<0.05).The death group had significantly lower cord blood ALB levels and globulin levels compared to the survival group (t=4.553, 2.784, P<0.01).Multivariate logistic regression analysis identified cord blood ALB as an independent protective factor against ELBW mortality (OR=0.742, 95%CI: 0.574 - 0.995, P<0.05).ROC curve analysis demonstrated that the optimal cutoff value for cord blood ALB was 28.5g/L. Conclusion Cord blood ALB has good predictive value for mortality in ELBW infants and can serve as an important indicator for early prognostic assessment and clinical intervention guidance.

关键词

超低出生体重儿 / 死亡 / 白蛋白 / 早产儿

Key words

extremely low birth weight infants / mortality / albumin / preterm infants

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基金资助

沧州市科技计划自筹经费项目(23244102021)