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重症肺炎合并糖尿病患者血糖波动与危重症评分和短期临床预后的相关性分析
作者:蒋璐1  龙瑜琴2  康小兰1 
单位:1. 重庆市大足区人民医院 全科医疗科, 重庆 402360;
2. 重庆市大足区人民医院 呼吸科, 重庆 402360
关键词:重症肺炎 糖尿病 血糖变异度 危重症评分 短期临床预后 
分类号:R563.1;R587.1
出版年·卷·期(页码):2017·36·第十二期(1714-1718)
摘要:

目的:探讨重症肺炎合并糖尿病患者血糖变异度与危重症评分和短期临床预后的相关性。方法:连续性纳入2015年6月至2017年1月我院呼吸科收治的84例重症肺炎合并糖尿病患者,根据28 d死亡事件分为存活组(n=59)和死亡组(n=25)。血糖波动评价指标包括入组时初始血糖(blood glucose on admission,BGad)、24 h平均血糖(mean blood glucose,BGm)及其标准差(standard deviation blood glucose,BGsd)、血糖变异系数(coefficient of blood glucose variability,BGcv)和血糖不稳定指数(blood glucose instability index,BGI)。病情危重程度评价指标包括急性生理与慢性健康评分Ⅱ评分(APACHE Ⅱ)、序贯器官衰竭评分(SOFA)、快速序贯器官衰竭评分(qSOFA)、改良早期预警评分(MEWS)、简化急性生理学评分Ⅲ(SAPS Ⅲ)。结果:死亡组接受肾脏替代治疗的患者比例明显高于存活组(P<0.05),死亡组患者机械通气时间、ICU滞留时间和总住院时间均明显长于存活组(P<0.05)。死亡组患者BGsd、BGcv和BGI水平均明显高于存活组患者[分别为(2.4±0.8) mmol·L-1 vs(1.6±0.5) mmol·L-1P<0.001;(44.32±5.66)%vs(21.53±4.81)%,P<0.001;(12.52±2.32)(mmol·L-12·h-1·d-1 vs(5.39±1.14)(mmol·L-12/h-1·d-1P<0.001]。BGcv和BGI对于28 d死亡事件的早期预测AUC分别为0.846和0.857,其中BGcv的cut-off值为51.3%,敏感性为84.6%,特异性为82.9%;BGI的cut-off值为15.7(mmol·L-12·h-1·d-1,敏感性为85.6%,特异性为82.8%。BGcv (r=0.677,P<0.001)和BGI (r=0.686,P<0.001)均与28 d死亡事件呈正相关。结论:重症肺炎合并糖尿病患者血糖剧烈波动可能预示短期预后不良,BGcv和BGI有助于早期预后评估。

Objective: To evaluated the correlation of glucose fluctuation, critical illness scores and 28-day mortality in patients with severe pneumonia and diabetes.Methods: A Total of eighty-four patients with severe pneumonia and diabetes were enrolled in this study and divided into death group(n=25) and survival group(n=59). All patients were received glucose fluctuation and critical illness score evaluation. The blood glucose on admission(BGad), mean blood glucose(BGm), standard deviation blood glucose(BGsd) and coefficient of variation (GLUcv) were calculated in each patient, coefficient of blood glucose variability(BGcv) and blood glucose instability index(BGI) were used as glucose swing estimation values. APACHE Ⅱ, SOFA, qSOFA, MEWS and SARS Ⅲ were used as critical evaluation index.Results: The numbers of continuous renal replacement therapytreatment and the days of mechanical ventilation, ICU hospital day and total hospital day in death group were higher than those in survival group(P<0.05). The levels of BGsd[(2.4±0.8) mmol·L-1 vs (1.6±0.5) mmol·L-1,P<0.001], BGcv[(44.32±5.66)% vs (21.53±4.81)%,P<0.001] and BGI[(12.52±2.32)(mmol·L-1)2·h-1·d-1 vs (5.39±1.14)(mmol·L-1)2·h-1·d-1,P<0.001] in death group were higher than those in survival group. ROC analysis showed that the AUC of BGcv and BGI for 28-day mortality were 0.846 and 0.857, respectively. The cut-off value of BGcv and BGI were 51.3 and 15.7, respectively. Correlation analysis showed that BGcv and BGI were positively related with 28-day mortality.Conclusion: BGcv and BGI may be used as blood glucose fluctuation value for early prognosis in severe pneumonia patients with diabetes mellitus.

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