非静脉曲张性上消化道出血中低白蛋白血症的患病率及意义

The prevalence and significance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding.

作者信息

Tung Chun-Fang, Chow Wai-Keung, Chang Chi-Sen, Peng Yen-chun, Hu Wei-Hsiung

机构信息

Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.

出版信息

Hepatogastroenterology. 2007 Jun;54(76):1153-6.

PMID:17629059

Abstract

BACKGROUND/AIMS: Hypoalbuminemia occurs in a variety of disease states and is associated with an increased rate of complications during hospitalization, resulting in an increased length of stay. However, there are no data about hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding. The purpose of this study is to evaluate the prevalence of hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding and to examine its significance in relation to severity and outcome of bleeding.

METHODOLOGY

This is a retrospective analysis of data collected prospectively on consecutive patients admitted to the Emergency Department of Taichung Veterans General Hospital with upper GI bleeding, and variceal bleeding was excluded. Hypoalbuminemia is defined as serum albumin < 3.5 g/dL. The outcome assessments in the hypoalbuminemia and normal albumin groups were compared.

RESULTS

There were three hundred and twenty-nine patients with non-variceal upper GI bleeding identified from July 2000 to January 2001. Two hundred and fifty were male, and 79 were female. Their ages ranged from 21 to 90 (64.60 +/- 14.84) years. Of these 329 patients eligible for the study, hypoalbuminemia was seen in 204 (62.0%). When compared to patients with normal serum albumin, the hypoalbuminemia group was older (66.81 +/- 13.45 vs. 60.98 +/- 16.29 years, P < 0.01), had more associated with underlying diseases (78.4% vs. 57.6%, P < 0.01), and had more leukocytosis (47.5% vs. 35.2%, P < 0.05), had lower hemoglobin (71.1% vs. 29.6% P < 0.01), and elevated BUN (85.3% vs. 72.8%, P < 0.01) at admission. In addition, these patients had longer hospital stay (6.82 +/- 9.45 vs. 2.38 +/- 3.48 days, P < 0.01), greater requirements of blood transfusion (5.76 +/- 7.43 vs. 1.38 +/- 2.20 units, P < 0.01), need of therapeutic endoscopy (41.7% vs. 16.0%, P < 0.01), with higher rebleeding rate (13.2% vs. 0%, P < 0.01), surgery rate (5.4% us. 0.8% P < 0.05), and mortality rate (9.3% vs. 0%, P < 0.01).

CONCLUSIONS

Hypoalbuminemia is common in patients with non-variceal upper GI bleeding, appears to reflect the severity of the bleeding episode, and is associated with a more complicated course.

摘要

背景/目的：低白蛋白血症发生于多种疾病状态，且与住院期间并发症发生率增加相关，导致住院时间延长。然而，尚无关于非静脉曲张性上消化道出血患者低白蛋白血症的相关数据。本研究旨在评估非静脉曲张性上消化道出血患者中低白蛋白血症的患病率，并探讨其与出血严重程度及预后的关系。

方法

这是一项对台中荣民总医院急诊科连续收治的上消化道出血患者前瞻性收集的数据进行的回顾性分析，排除了静脉曲张出血患者。低白蛋白血症定义为血清白蛋白<3.5g/dL。比较低白蛋白血症组和正常白蛋白组的预后评估情况。

结果

2000年7月至2001年1月共确定329例非静脉曲张性上消化道出血患者。其中男性250例，女性79例。年龄范围为21至90岁（64.60±14.84岁）。在这329例符合研究条件的患者中，204例（62.0%）存在低白蛋白血症。与血清白蛋白正常的患者相比，低白蛋白血症组年龄更大（66.81±13.45岁对60.98±16.29岁，P<0.01），合并基础疾病更多（78.4%对57.6%，P<0.01），入院时白细胞增多更常见（47.5%对35.2%，P<0.05），血红蛋白更低（71.1%对29.6%，P<0.01），血尿素氮升高（85.3%对72.8%，P<0.01）。此外，这些患者住院时间更长（6.82±9.45天对2.38±3.48天，P<0.01），输血需求量更大（5.76±7.43单位对1.38±2.20单位，P<0.01），需要治疗性内镜检查的比例更高（41.7%对16.0%，P<0.01），再出血率更高（13.2%对0%，P<0.01），手术率更高（5.4%对0.8%，P<0.05），死亡率更高（9.3%对0%，P<0.01）。