乳酸/白蛋白比值对早产儿并发呼吸衰竭的预测价值

Predictive value of the lactate-to-albumin ratio for respiratory failure in premature infants

摘要:

目的 探讨乳酸/白蛋白比值（LAR）对早产儿并发呼吸衰竭的预测价值。方法 回顾性选取2023年1月—2025年6月安庆市立医院新生儿重症监护室收治的288例早产儿作为研究对象。根据住院期间是否并发呼吸衰竭，将患儿分为呼吸衰竭组（102例）和非呼吸衰竭组（186例）。收集并比较两组患儿的一般资料、血清乳酸（Lac）、白蛋白（Alb）水平及LAR。采用受试者工作特征（ROC）曲线评估LAR对早产儿并发呼吸衰竭的预测价值。采用多因素逐步Logistic回归模型分析早产儿并发呼吸衰竭的危险因素。结果 非呼吸衰竭组与呼吸衰竭组的胎龄、患儿性别构成、分娩方式构成、胎膜早破构成、妊娠高血压率、妊娠糖尿病率、双胎或多胎率、羊水污染率及住院时间比较，差异均无统计学意义（P >0.05）。呼吸衰竭组出生体重低于非呼吸衰竭组（P <0.05），1 min Apgar评分≤7分及5 min Apgar评分≤7分占比均高于非呼吸衰竭组（P <0.05）。呼吸衰竭组患儿Lac水平和LAR均高于非呼吸衰竭组（P <0.05），Alb水平低于非呼吸衰竭组（P <0.05）。Lac、Alb及LAR预测早产儿并发呼吸衰竭的曲线下面积分别为0.807（95% CI：0.762，0.852）、0.793（95% CI：0.748，0.843）、0.920（95% CI：0.875，0.970）。当Lac、Alb及LAR的截断值分别为3.30 mmol/L、27.43 g/L和0.13时，Lac的特异性为55.78%（95% CI：0.486，0.629），敏感性为90.25%（95% CI：0.845，0.960）；Alb的特异性为65.34%（95% CI：0.585，0.722），敏感性为91.38%（95% CI：0.859，0.968）；LAR的特异性为85.19%（95% CI：0.801，0.903），敏感性为86.42%（95% CI：0.798，0.931）。多因素逐步Logistic回归分析结果显示，低出生体重、Alb ≤27.43 g/L、Lac ≥3.30 mmol/L、LAR ≥0.13均为早产儿并发呼吸衰竭的危险因素（P <0.05）。结论 LAR与早产儿并发呼吸衰竭密切相关，LAR ≥0.13是预测该并发症的独立危险因素，且预测效能优于单一指标。

Abstract:

Objective To investigate the predictive value of the lactate-to-albumin ratio (LAR) for respiratory failure in premature infants.Methods A retrospective study was conducted on 288 premature infants admitted to the neonatal intensive care unit of Anqing Municipal Hospital from January 2023 to June 2025. The infants were divided into a respiratory failure group (n = 102) and a non-respiratory failure group (n = 186) according to whether respiratory failure occurred during hospitalization. General data, serum lactate (Lac) and albumin (Alb) levels, and LAR were collected and compared between the two groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of LAR for respiratory failure in premature infants. Multivariate stepwise logistic regression was used to analyze the risk factors for respiratory failure in premature infants.Results There were no significant differences between the non-respiratory failure group and the respiratory failure group in gestational age, sex distribution, mode of delivery, premature rupture of membranes, gestational hypertension, gestational diabetes, twin or multiple pregnancy, amniotic fluid contamination, or length of hospital stay (P > 0.05). Birth weight was lower in the respiratory failure group than in the non-respiratory failure group, whereas the proportions of infants with 1-min and 5-min Apgar scores ≤ 7 were higher (P < 0.05). Lac levels and LAR were higher, whereas Alb levels were lower, in the respiratory failure group than in the non-respiratory failure group (P < 0.05). The areas under the ROC curve for Lac, Alb, and LAR in predicting respiratory failure in premature infants were 0.807 (95% CI: 0.762, 0.852), 0.793 (95% CI: 0.748, 0.843), and 0.920 (95% CI: 0.875, 0.970), respectively. At cutoff values of 3.30 mmol/L, 27.43 g/L, and 0.13, respectively, the specificity and sensitivity were 55.78% (95% CI: 0.486, 0.629) and 90.25% (95% CI: 0.845, 0.960) for Lac, 65.34% (95% CI: 0.585, 0.722) and 91.38% (95% CI: 0.859, 0.968) for Alb, and 85.19% (95% CI: 0.801, 0.903) and 86.42% (95% CI: 0.798, 0.931) for LAR. Multivariate stepwise logistic regression analysis showed that low birth weight, Alb ≤ 27.43 g/L, Lac ≥ 3.30 mmol/L, and LAR ≥ 0.13 were risk factors for respiratory failure in premature infants (P < 0.05).Conclusion LAR is closely associated with respiratory failure in premature infants. An LAR ≥ 0.13 is an independent risk factor for this complication and has better predictive performance than either individual indicator.