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中华临床医师杂志(电子版) ›› 2025, Vol. 19 ›› Issue (07) : 479 -485. doi: 10.3877/cma.j.issn.1674-0785.2025.07.001

临床研究

重症肺炎患者血磷水平轨迹与短期预后之间的关系
高兴梅1, 周洁容1, 杨溢1, 张孟祥1, 张仲谋1, 李斌1,2,()   
  1. 1 730000 兰州,兰州大学第一临床医学院
    2 730000 兰州,兰州大学第一医院重症医学科
  • 收稿日期:2025-06-03 出版日期:2025-07-30
  • 通信作者: 李斌
  • 基金资助:
    国家自然科学基金地区科学基金(82160358)

Relationship between serum phosphorus level trajectory and short-term prognosis in patients with severe pneumonia

Xingmei Gao1, Jierong Zhou1, Yi Yang1, Mengxiang Zhang1, Zhongmou Zhang1, Bin Li1,2,()   

  1. 1 Lanzhou University, The First Hospital of Lanzhou University, Lanzhou 730000, China
    2 Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
  • Received:2025-06-03 Published:2025-07-30
  • Corresponding author: Bin Li
引用本文:

高兴梅, 周洁容, 杨溢, 张孟祥, 张仲谋, 李斌. 重症肺炎患者血磷水平轨迹与短期预后之间的关系[J/OL]. 中华临床医师杂志(电子版), 2025, 19(07): 479-485.

Xingmei Gao, Jierong Zhou, Yi Yang, Mengxiang Zhang, Zhongmou Zhang, Bin Li. Relationship between serum phosphorus level trajectory and short-term prognosis in patients with severe pneumonia[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(07): 479-485.

目的

探究血磷水平变化轨迹与重症肺炎患者短期预后之间的关系。

方法

回顾性分析兰州大学第一医院重症医学科收治的1055例重症肺炎患者的临床资料,根据患者住院期间的血磷水平变化情况,对血磷水平进行轨迹分析,根据轨迹对患者进行分组。分析不同组患者之间的基础资料,并做K-M生存曲线,进行单因素及多因素COX回归分析,分析不同血磷水平轨迹与患者机械通气比例、机械通气时间、28 d生存情况之间的关系。

结果

纳入的1055名患者被分为三个轨迹组,分别为持续低磷组、血磷正常组和进行性低磷组。持续低磷组死亡率更高,气管插管比例及机械通气时间更长。COX生存分析结果显示血磷正常组患者死亡风险更低(HR=0.594,95%CI:0.388~0.908),校正SOFA评分、APACHE Ⅱ评分、年龄、乳酸、血清钙、单核细胞绝对值、淋巴细胞绝对值、气管插管、呼吸机使用时间等混杂因素后结果仍然显著。

结论

持续低磷血症与患者的不良预后相关,维持血磷水平正常稳定有助于改善患者短期预后。

Objective

To explore the relationship between the trajectory of blood phosphorus levels and the clinical outcome of patients with severe pneumonia.

Methods

The clinical data of 1055 patients with severe pneumonia admitted to the Department of Critical Care Medicine of the First Hospital of Lanzhou University were retrospectively analyzed. According to the changes of blood phosphorus level during hospitalization, the trajectory analysis of blood phosphorus level was carried out, and the patients were grouped according to the trajectory. The basic data between different groups of patients were analyzed, and the Kaplan-Meier survival curve was performed. Univariate and multivariate COX regression analyses were performed to explore the relationship between different blood phosphorus level trajectories and the proportion of mechanical ventilation, mechanical ventilation time, and 28-day survival.

Results

A total of 1055 patients were divided into three trajectory groups: persistent hypophosphatemia group, normal serum phosphorus level group, and progressive hypophosphatemia group. The mortality rate was higher in the persistent hypophosphatemia group, and the proportion of tracheal intubation, mechanical ventilation time, and hospitalization time were longer. COX survival analysis showed that patients with normal serum phosphorus levels had a lower risk of death (hazard ratio=0.594, 95% confidence interval: 0.388~0.908). After adjusting for confounding factors such as SOFA score, APACHE II score, age, lactic acid, serum calcium, absolute monocyte count, absolute lymphocyte count, tracheal intubation, and ventilator use time, the results were still significant.

Conclusion

Persistent hypophosphatemia is associated with a poor prognosis in patients with severe pneumonia. Maintaining normal and stable serum phosphorus level is helpful to improve the short-term prognosis of such patients.

图1 血磷轨迹分组
表1 不同轨迹组患者基线特征比较
变量 轨迹1(n=614) 轨迹2(n=315) 轨迹3(n=126) χ2/H/F P
年龄(岁)MP25P75 68(56,76) 67(55,75) 67(57,77) 2.683 0.261
性别(男性)[例(%)] 348(56.7) 187(59.4) 61(48.4) 4.413 0.110
身高[cm,MP25P75)] 168(160,172) 170(160,173) 168(160,172) 0.451 0.798
体重[kg,MP25P75)] 60(54,70) 66(56,76) 57(50,74) 4.334 0.115
SOFA评分[分,MP25P75)] 12(10,13) 11(10,13) 12(10,13) 2.301 0.316
APACHE Ⅱ评分[分,MP25P75)] 23(22,25) 23(22,25) 23(22,24) 1.973 0.373
SaO2[%,MP25P75)] 94(88,98) 93(89,97) 92(79,98) 1.940 0.379
红细胞(1012/L,
±s
4.08±1.07 4.00±0.97 3.88±1.07 1.718 0.180
血红蛋白(g/L,
±s
124.57±33.64 122.79±29.48 117.63±34.03 1.892 0.151
白细胞[109/L,MP25P75)] 7.72(5.18,11.77) 7.93(5.41,12.37) 8.21(5.37,13.09) 0.596 0.742
血小板[109/L,MP25P75)] 172.50(119,229.75) 164.00(111,237.00) 140.00(101.00,184.00) 4.630 0.099
淋巴绝对值[109/L,MP25P75)] 0.66(0.40,1.03) 0.66(0.39,1.06) 0.76(0.42,1.03) 0.597 0.742
单核绝对值[109/L,MP25P75)] 0.39(0.24,0.62) 0.41(0.24,0.62) 0.41(0.20,0.68) 0.172 0.918
谷丙转氨酶[U/L,MP25P75)] 24.00(15.00,44.00) 24.00(15.00,52.25) 21.00(13.00,52.00) 0.182 0.913
谷草转氨酶[U/L,MP25P75)] 31.00(21.00,60.00) 34.50(22.00,62.00) 28.00(21.00,54.00) 0.024 0.327
葡萄糖[mmol/L,MP25P75)] 7.40(5.48,10.62)) 7.40(5.50,10.62) 8.17(5.31,11.77) 0.748 0.988
总胆红素[µmol/L,MP25P75)] 16.10(11.60,25.25) 15.30(11.40,22.90) 16.50(11.05,31.65) 5.003 0.082
间接胆红素[µmol/L,MP25P75)] 11.45(8.40,17.10) 11.00(7.90,15.38) 11.80(7.60,19.25) 2.684 0.261
白蛋白[g/L,MP25P75)] 33.40(29.80,37.80) 33.30(30.33,37.35) 32.90(29.85,38.50) 0.042 0.979
碱性磷酸酶[U/L,MP25P75)] 79.35(61.52,111.68) 79.00(60.40,108.58) 79.11(61.35,113.15) 0.502 0.778
甘油三酯[mmol/L,MP25P75)] 1.15(0.83,1.67) 1.22(0.88,1.73) 1.25(0.88,1.67) 2.319 0.314
胆固醇[mmol/L,MP25P75)] 3.16(2.47,3.98) 3.43(2.68,4.12) 3.15(2.41,3.94) 4.602 0.100
血肌酐[µmol/L,MP25P75)] 72.1(58.18,89) 73.1(59.3,90.08) 71.50(57.95,93.73) 0.845 0.655
尿素氮[mmol/L,MP25P75)] 6.41(4.81,8.00) 6.37(5.00,8.48) 6.69(4.99,9.27) 3.567 0.168
钠[mmol/L,MP25P75)] 136.8(133,140) 137(134,140.1) 137.4(132.3,139.9) 1.702 0.427
钙[mmol/L,MP25P75)] 1.96(1.85,2.09) 1.96(1.84,2.07) 1.97(1.82,2.13) 0.620 0.733
乳酸[mmol/L,MP25P75)] 1.60(1.10,2.60) 1.80(1.20,2.40) 2.10(1.35,2.90) 5.141 0.076
表2 2组不同患者结局比较
图2 3组患者生存曲线
表3 重症肺炎患者生存结局的多因素Cox回归分析
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