空军军医大学学报2025，Vol.46Issue(6)：746-754,9.DOI:10.13276/j.issn.2097-1656.2025.06.008
高原性肺水肿高压氧治疗前后血清乳酸水平变化与预后相关性
Correlation between changes of serum lactic acid level and prognosis before and after hyperbaric oxygen treatment in high-altitude pulmonary edema
摘要
Abstract
Objective To explore the changes of serum lactic acid(LAC)level before and after hyperbaric oxygen(HBO)treatment in high-altitude pulmonary edema(HAPE)and its correlation with prognosis.Methods In this study,165 HAPE patients who received HBO treatment in Wenzhou People's Hospital from June 2020 to June 2023 were selected,and general data,blood routine parameters,blood biochemical tests,liver and kidney function,coagulation function indexes,inflammatory factor levels and other related clinical data of the subjects were statistically analyzed.According to the evaluation criteria of efficacy,patients with curative effect were divided into good prognosis group(n=118),and patients with effective and ineffective efficacy were divided into poor prognosis group(n=47).Logistic regression was used to analyze the relationship between LAC and prognosis of HBO treatment in HAPE patients.Subgroup analysis was performed to analyze the correlation between LAC and the risk of poor prognosis after HBO treatment in HAPE patients.Locally weighted scatterplot smoothing(LOWESS)was used to analyze the two-dimensional curve relationship of continuous variables.The interaction between blood flow in cerebral microcirculation and vascular growth factor was analyzed.The dose-response relationship between blood flow in cerebral microcirculation and poor prognosis was analyzed by restricted cubic splines.Finally,decision curve analysis(DCA)of blood flow in cerebral microcirculation was performed.Results Compared with before HBO treatment,there were statistically significant differences in heart rate,respiratory frequency,arterial oxygen saturation,arterial partial pressure of carbon dioxide,arterial partial pressure of oxygen,albumin(Alb),globulin(Glb),red blood cell count,LAC,lactate dehydrogenase(LDH),blood uric acid,urine uric acid,serum aspartate aminotransferase(AST),α-hydroxybutyrate dehydrogenase(α-HBDH),and creatine kinase(CK)in HAPE patients after treatment(P＜0.05).Among the HAPE patients treated with HBO,the indexes of Alb,Glb,LAC,LDH,AST,α-HBDH and CK in the poor prognosis group were significantly higher than those in the good prognosis group(P＜0.05).Multivariate logistic regression analysis showed that LAC,LDH,Alb,α-HBDH and CK were independent influencing factors of poor prognosis in HAPE patients(P＜0.05).In the Alb,LDH,α-HBDH and CK subgroups,there was a stable correlation between LAC and the risk of poor prognosis after HBO treatment in HAPE patients,and there was no interaction between subgroups(Pinteraction＞0.05).LOWESS analysis showed that Alb,LDH,α-HBDH,CK and LAC all had a certain nonlinear relationship,and LAC was positively correlated with Alb,LDH,α-HBDH and CK(P＜0.05).Restricted cubic spline analysis showed that the continuous change of LAC was correlated with poor prognosis in a nonlinear dose-response manner,and LAC was positively correlated with poor prognosis(P＜0.05).When LAC was greater than the cutoff value of 1.56 mmol/L,the risk of poor prognosis increased significantly with the increase of LAC level.DCA showed that LAC had important clinical value in predicting the prognosis of patients.Conclusion High-level LAC is an independent factor affecting the poor prognosis of HAPE patients,and it is positively correlated with poor prognosis.This index may be helpful to evaluate the prognosis of HAPE patients.关键词
高原性肺水肿/高压氧/血清乳酸/预后Key words
high-altitude pulmonary edema/hyperbaric oxygen/serum lactic acid/prognosis分类
临床医学引用本文复制引用
汤程远..高原性肺水肿高压氧治疗前后血清乳酸水平变化与预后相关性[J].空军军医大学学报,2025,46(6):746-754,9.基金项目
浙江省医药卫生科技计划项目(2020KY657) （2020KY657）
