临床小儿皮肤科 开放获取

抽象的

2018 年兒科護理：微量白蛋白尿水平與危重兒童的 PRISM 和 PELOD 評分以及死亡率預測相關嗎 - Karan Raheja - Sir Ganga Ram Hospital

卡蘭·拉赫賈

介紹：

微量白蛋白尿的特徵是 24 小時尿液收集中的白蛋白水平為 30 至 300 毫克。清白蛋白尿、大量白蛋白尿或蛋白尿的特徵是尿液白蛋白排出量≥300 mg/24 小時。尿蛋白尿涉及 20-70% 或尿完全蛋白排泄。透過試紙估計尿液白蛋白排泄而不同時估計肌酸酐取決於假陰性和假陽性結果，因為水合水平引起尿液濃度的變化。儘管尿液試紙可用於快速篩檢，但仍應進行其他逐步精確的估計來測量尿液白蛋白排出率 (AER)。可以透過幾種不同的方式估計白蛋白尿，在隨機或第一​​次早晨現場收集中估計白蛋白與肌酸酐比值(ACR)，24 小時尿液分類並估計肌酸酐以驗證收集的充分性，並協調（ 4 小時）或隔夜）小便品種。儘管 24 小時尿液收集可以解決白蛋白排出量的晝夜變化問題，但它取決於分類錯誤。腎臟疾病結果品質倡議規則表明，第一天早上的尿液收集中的 ACR 估計是令人滿意的，並且計劃的尿液收集並不重要。儘管如此，由於女性排出的肌酸酐比男性少，且微量白蛋白尿取決於每天尿白蛋白排出量的固定值，因此在使用 ACR 時，微量白蛋白尿的含義對於人們來說是不同的。

Microalbuminuria was first characterized by Mogensen and others as 30–300 mg urinary albumin discharge per 24 h. Be that as it may; at that point, there was not boundless utilization of inhibitors of the renin angiotensin framework. As noted underneath, restraint of the renin angiotensin framework diminishes urinary albumin discharge, and medications to repress the renin angiotensin framework are as of now in wide use. Micro albuminuria (MA), a sub-clinical increase in urinary albumin, is a recognized marker of systemic inflammation, and is thought to reflect the glomerular component of a systemic capillary leak. Previous research has shown that sustained MA is associated with the development of organ dysfunction later on and poor outcome in adults. To date, the relationship of MA and organ system dysfunction (OSD) in critically ill children have not been systematically evaluated. The purpose of this study was to examine the relationship between MA and OSD in critically ill children.

Methods: Eligible subjects were patients <16 years and more one month of age, who were admitted to the PICU, and with anticipated to stay >24 hrs. Patients with primary nephropathies or gross hematuria were excluded. Microalbuminuria (ACR) were obtained from each patient at admission (ACR1), at 12hrs (ACR2) and at 24hrs (ACR3) and expressed in mcg/mg of creatinine. Cut off for significant microalbuminuria was taken as 180mcg/mg. Every day PELOD scores were determined for every patient and PRISM score at 12 and 24 hours. Connections among's PRISM and PELOD with microalbuminuria were determined. Additionally we attempted to discover survivor and non-survivor relationship with microalbuminuria.

Results: The sample included 138 patients, with sepsis with a median age of 38 months (range 1 to 192), median weight 13kgs (range 2.4 to 69), median PRISM score in patient with microalbuminuria levels >180mcg/mg was high 8 (range 6 to 12) in comparison to others in which levels was <180mcg/mg 4 (range 2 to 8) and median PELOD scores was high 21 (range 12 to 23) in group with microalbuminuria levels >180mcg/mg to others with levels <180mcg/mg 9 (range1 to 20). There is also statistically significant difference between types of sepsis in case of microalbuminuria at admission, 12hrs and 24hrs P=0.01 (P<0.05). Using Mann-Whitney test used for comparison between 2 groups (survivors vs. non-survivors) showed that there is no statistically significant difference between outcome in case of microalbuminuria on admission P=0.256 (P>.05). But, there is statistically significant difference between outcome in case of microalbuminuria at 12hrs P=0.037 (P<0.05) and 24hrs P=0.016 (P<0.05).

結論：本研究顯示重症兒童微量白蛋白尿與器官系統功能障礙程度有顯著相關性。它還表明，如果趨勢逐漸增加，微量白蛋白尿的上升預示著器官功能障礙的惡化和死亡風險的增加。微量白蛋白尿可以快速測定，價格便宜，節省血液，並且可能在危重兒童的臨床評估中發揮作用。