严重烧伤患者休克期白蛋白平衡状态与MODS的关系及发生白蛋白负平衡的危险因素分析

孙然然; 郎静远; 高世杰; 衡雪; 陈丹丹; 李步潆; 李海胜; 罗高兴

doi:10.3760/cma.j.cn501225-20250616-00268

严重烧伤患者休克期白蛋白平衡状态与MODS的关系及发生白蛋白负平衡的危险因素分析

doi: 10.3760/cma.j.cn501225-20250616-00268

陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所,创伤与化学中毒全国重点实验室,重庆　400038

基金项目:

陆军军医大学第一附属医院临床研究孵化项目重大项目 2024IITZDA01

详细信息

通讯作者:
罗高兴,Email：logxw@tmmu.edu.cn

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出版历程
- 收稿日期: 2025-06-16
- 网络出版日期: 2026-10-16

Analysis of the relationship between albumin balance status during the shock phase and MODS in patients with severe burns and the risk factors for the occurrence of negative albumin balance

Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China

Funds:

Major Project of the Clinical Research Incubation Program of the First Affiliated Hospital of Army Medical University 2024IITZDA01

More Information

Corresponding author: Luo Gaoxing, Email: logxw@tmmu.edu.cn

摘要

摘要: 目的分析严重烧伤患者休克期白蛋白平衡状态与多器官功能障碍综合征（MODS）的关系及发生白蛋白负平衡的危险因素。方法该研究为回顾性病例系列研究。2023年1月1日—2024年12月31日,陆军军医大学（第三军医大学）第一附属医院收治89例符合入选标准的严重烧伤患者,其中男73例、女16例,年龄（48±14）岁。采集患者入院时白蛋白测量值,基于Nadler公式估算血容量与血浆容量并引入外源性与内源性白蛋白代谢半衰期进行衰减校正,计算伤后48 h白蛋白平衡值,统计白蛋白负平衡发生情况。对患者入院时白蛋白测量值与伤后48 h白蛋白平衡值行相关分析。将伤后48 h白蛋白平衡值≤0 g/L的患者纳入负平衡组（14例）,>0 g/L的患者纳入正平衡组（75例）。比较2组患者烧伤总面积、Ⅲ度烧伤面积,伤后48 h中性粒细胞百分比与白蛋白比值（NPAR）、系统炎症综合指数（AISI）、全身炎症反应指数（SIRI）、全身免疫炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、改良序贯器官衰竭评估（SOFA）评分及MODS发生情况。筛选影响严重烧伤患者伤后48 h发生白蛋白负平衡的独立危险因素。结果患者入院时白蛋白测量值为（28±7）g/L,伤后48 h白蛋白平衡值为9.01（3.06,19.62）g/L,15.73%（14/89）的患者发生白蛋白负平衡。患者入院时白蛋白测量值与伤后48 h白蛋白平衡值呈显著正相关（rs=0.349,P<0.05）。负平衡组患者烧伤总面积、Ⅲ度烧伤面积均明显大于正平衡组（Z值分别为-3.736、-4.096,P<0.05）,伤后48 h AISI、SIRI、SII、NPAR、MLR、改良SOFA评分、MODS发生比例均明显高于正平衡组（Z值分别为-2.310、-2.186、-2.130、-3.629、-2.108、-2.597,χ²=11.168,P<0.05）。单因素logistic回归分析结果显示,烧伤总面积和Ⅲ度烧伤面积以及伤后48 h NPAR、AISI、SIRI、SII、NLR、MLR、改良SOFA评分均为严重烧伤患者伤后48 h发生白蛋白负平衡的危险因素（OR分别为1.061、1.053、3.181、2.350、2.483、2.014、2.026、2.316、1.283,95%CI分别为1.028~1.094、1.025~1.081、1.635~6.189、1.193~4.631、1.250~4.932、1.061~3.821、1.025~4.008、1.167~4.597、1.065~1.546,P<0.05）。多因素logistic回归分析结果显示,Ⅲ度烧伤面积和伤后48 h SII均为严重烧伤患者伤后48 h发生白蛋白负平衡的独立危险因素（OR分别为1.055、2.347,95%CI分别为1.026~1.086、1.129~4.880,P<0.05）。结论严重烧伤患者休克期白蛋白负平衡与MODS的发生可能相关,Ⅲ度烧伤面积和伤后48 h SII是患者发生白蛋白负平衡的独立危险因素。
- 烧伤 /
- 低白蛋白血症 /
- 代谢 /
- 多器官功能衰竭 /
- 预后 /
- 危险因素
Abstract: Objective To analyse the relationship between albumin balance status during the shock phase and multiple organ dysfunction syndrome (MODS) in patients with severe burns and the risk factors for the occurrence of negative albumin balance. Methods This study was a retrospective case series study. From January 1^st, 2023 to December 31^st, 2024, 89 patients with severe burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Army Medical University (Third Military Medical University), including 73 males and 16 females, aged (48±14) years. The albumin level at admission was collected, and blood volume and plasma volume were estimated based on the Nadler formula, with attenuation correction using the metabolic half-lives of exogenous and endogenous albumin, the albumin balance value at 48 h post-injury was calculated. Patients with an albumin balance value of ≤0 g/L at 48 h post-injury were included in negative balance group (n=14), while those with an albumin value of >0 g/L were included in positive balance group (n=75). The two groups were compared in terms of burn severity indicators such as total burn area and full-thickness burn area; inflammatory indicators at 48 h post-injury such as the neutrophil percentage-to-albumin ratio (NPAR), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR); and organ injury indicators at 48 h post-injury such as the modified sequential organ failure assessment (SOFA) score and the incidence of MODS. The independent risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns were screened. Results In the 89 patients, the albumin level at admission was (28±7) g/L and the albumin balance value at 48 h post-injury was 9.01 (3.06, 19.62) g/L, with 15.73% (14/89) of the patients developing negative albumin balance. The albumin level at admission was significantly positively correlated with the albumin balance value at 48 h post-injury (rs=0.349, P<0.05). There were statistically significant differences between patients in negative balance group and positive balance group in terms of total burn area, full-thickness burn area, and AISI, SIRI, SII, NPAR, MLR, modified SOFA score and percentage of patients with MODS at 48 h post-injury (with Z values of -3.736, -4.096, -2.310, -2.186, -2.130, -3.629, -2.108, and -2.597, χ²=11.168, respectively, P<0.05). Univariate logistic regression analysis results showed that total burn area, full-thickness burn area, and NPAR, AISI, SIRI, SII, NLR, MLR, and modified SOFA score at 48 h post-injury were the risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns (with ORs of 1.061, 1.053, 1.116, 1.003, 1.240, 2.073, 1.082, 3.810 and 1.283, respectively, 95% CIs of 1.028-1.094, 1.025-1.081, 1.045-1.191, 1.001-1.004, 1.093-1.407, 1.227-3.501, 1.020-1.147, 1.627-8.923, and 1.065-1.546, respectively, P<0.05). Multivariate logistic regression analysis results showed that full-thickness burn area and SII at 48 h post-injury were the independent risk factors for the occurrence of negative albumin balance at 48 h post-injury in patients with severe burns (with ORs of 1.056 and 2.321, respectively, 95% CIs of 1.015-1.099 and 1.185-4.549, respectively, P<0.05). Conclusions Negative albumin balance during the shock phase was closely associated with the incidence of MODS in patients with severe burns, with full-thickness burn area and SII at 48 h post-injury were the independent risk factors for the occurrence of negative albumin balance.
- Burns /
- Hypoalbuminemia /
- Metabolism /
- Multiple organ failure /
- Prognosis /
- Risk factors
孙然然：研究设计、论文撰写；郎静远、高世杰、衡雪、陈丹丹、李步潆：数据收集、统计分析；李海胜：研究设计、论文修改；罗高兴：研究指导、经费支持

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图 1 89例严重烧伤患者入院时白蛋白测量值不同分层下伤后48 h白蛋白平衡值的分布及二者的相关性

注：按入院时白蛋白测量值将患者分为4层（<20.00、20.00~<25.00、25.00~30.00、>30.00 g/L）,图中红色实线示伤后48 h白蛋白平衡值=0；2例患者数据超出坐标轴范围未予显示（1例入院时白蛋白测量值51.60 g/L、1例伤后48 h白蛋白平衡值-63.85 g/L）；入院时白蛋白测量值与伤后48 h白蛋白平衡值呈显著正相关,rs=0.349,P<0.001

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Table 1. 2组严重烧伤患者临床和实验室检测指标比较

组别	例数	性别（例）		年龄（岁,x¯±s）	伤后入院时间[h,M（Q₁,Q₃）]	烧伤总面积[%TBSA,M（Q₁,Q₃）]	Ⅲ度烧伤面积[%TBSA,M（Q₁,Q₃）]	合并吸入性损伤（例）	基础性疾病（例）
组别	例数	男	女	年龄（岁,x¯±s）	伤后入院时间[h,M（Q₁,Q₃）]	烧伤总面积[%TBSA,M（Q₁,Q₃）]	Ⅲ度烧伤面积[%TBSA,M（Q₁,Q₃）]	合并吸入性损伤（例）	基础性疾病（例）
正平衡组	75	63	12	48±14	6.00（4.00,10.50）	40.00（33.50,53.00）	15.00（5.00,26.00）	47	19
负平衡组	14	10	4	50±19	7.50（6.25,9.00）	71.50（60.50,88.75）	42.00（35.25,79.25）	12	6
统计量值		—		t=-0.452	Z=-0.963	Z=-3.736	Z=-4.096	—	—
P值		0.269		0.652	0.335	<0.001	<0.001	0.127	0.204
注：将伤后48 h白蛋白平衡值>0 g/L的患者纳入正平衡组,≤0 g/L的患者纳入负平衡组；“—”表示无此项；TBSA为体表总面积,AISI为系统炎症综合指数,SIRI为全身炎症反应指数,SII为全身免疫炎症指数,NPAR为中性粒细胞百分比与白蛋白比值,NLR为中性粒细胞与淋巴细胞比值,MLR为单核细胞与淋巴细胞比值,SOFA为序贯器官衰竭评估,MODS为多器官功能障碍综合征

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Table 2. 89例严重烧伤患者伤后48 h发生白蛋白负平衡影响因素的单因素logistic回归分析结果

自变量	OR	95%CI	P值
性别（以男性为参照）	2.100	0.565~7.811	0.268
年龄（岁）	1.009	0.970~1.050	0.648
伤后入院时间（h）	0.992	0.926~1.063	0.816
烧伤总面积（%TBSA）	1.061	1.028~1.094	<0.001
Ⅲ度烧伤面积（%TBSA）	1.053	1.025~1.081	<0.001
合并吸入性损伤（以无吸入性损伤为参照）	3.574	0.745~17.153	0.111
基础性疾病（以无基础性疾病为参照）	2.211	0.680~7.190	0.187
休克期补液系数（mL·kg^-1·%TBSA^-1）	0.370	0.074~1.851	0.226
休克期电解质系数（mL·kg^-1·%TBSA^-1）	0.315	0.046~2.157	0.239
休克期胶体系数（mL·kg^-1·%TBSA^-1）	0.570	0.031~10.606	0.706
休克期尿量（mL·kg^-1·h^-1）	0.160	0.014~1.892	0.146
伤后48 h NPAR（ln值）	3.181	1.635~6.189	<0.001
伤后48 h AISI（ln值）	2.350	1.193~4.631	0.014
伤后48 h SIRI（ln值）	2.483	1.250~4.932	0.009
伤后48 h SII（ln值）	2.014	1.061~3.821	0.032
伤后48 h NLR（ln值）	2.026	1.025~4.008	0.042
伤后48 h MLR（ln值）	2.316	1.167~4.597	0.016
伤后48 h改良SOFA评分（分）	1.283	1.065~1.546	0.009
注：TBSA为体表总面积,NPAR为中性粒细胞百分比与白蛋白比值,AISI为系统炎症综合指数,SIRI为全身炎症反应指数,SII为全身免疫炎症指数,NLR为中性粒细胞与淋巴细胞比值,MLR为单核细胞与淋巴细胞比值,SOFA为序贯器官衰竭评估