>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
呼吸危重症患者血糖水平与炎症指标的相关性研究
作者:王婴云  陶珍  彭海菁  周承惇 
单位:中山大学附属第八医院(深圳福田) 重症监护病房, 广东 深圳 518033
关键词:呼吸危重症 初次血糖 血糖变异度 炎症指标 预后 
分类号:R563
出版年·卷·期(页码):2018·37·第三期(458-462)
摘要:

目的:探讨呼吸危重症患者入重症监护病房(ICU)初次血糖及24 h内血糖变异度与炎症指标之间的相关性,评价其对预后的预测价值。方法:纳入我院综合ICU收治的85例呼吸危重症患者,记录入ICU后24 h内的血糖水平。根据入ICU初次血糖水平分为A组(血糖水平≤ 6.9 mmol·L-1)、B组(血糖水平7.0~10.0 mmol·L-1)、C组(血糖水平>10.0 mmol·L-1)3组,比较3组平均血糖(GLUave)、血糖标准差(GLUsd)及血糖变异系数(GLUcv),检测降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平,进行急性生理慢性健康评分Ⅱ(APACHEⅡ)评分,分析入ICU初次血糖与以上指标的关系,采用受试者工作特征曲线(ROC曲线)评价上述指标对预后的预测价值。结果:C组24 h GLUave、GLUsd、GLUcv、PCT水平均显著高于A组及B组(均P<0.05),A组与B组间GLUave、GLUsd、GLUcv、PCT水平差异均无统计学意义(均P>0.05)。3组间APACHEⅡ评分和hs-CRP水平差异无统计学意义(均P>0.05)。ROC曲线下面积(AUC) APACHEⅡ评分为0.803,PCT为0.756,hs-CRP为0.711,GLUcv为0.660,GLUsd为0.565,GLUave为0.570。结论:在进入ICU的首个24 h内,呼吸危重症患者的血糖变异度、炎症指标与入ICU初次血糖水平密切相关,入ICU初次血糖水平高于10 mmol·L-1的患者血糖变异度最大,炎症反应最重;在各项指标中,APACHEⅡ对呼吸危重症患者预后的预测价值最高,炎症指标PCT、hs-CRP的预测价值高于血糖变异指标GLUcv、GLUsd、GLUave。

Objective: To investigate the relationship between initial glucose, glucose variability and inflammatory markers in respiratory critical ill patients admitted to intensive care unit(ICU) in the first 24 hours and to evaluate the predictive value of the above indicators for the outcome of the patients.Methods: A total of 85 respiratory critical ill patients in ICU were enrolled and the glucose level of the patients was recorded within the first 24 hours when admitted in ICU. According to the initial glucose level, the patients were divided into three groups:group A(glucose ≤ 6.9 mmol·L-1), group B(glucose 7.0-10.0 mmol·L-1) and group C(glucose>10.0 mmol·L-1). The mean glucose(GLUave), standard deviation of glucose(GLUsd) and coefficient of variation(GLUcv) were calculated, and the inflammatory markers,i.e. hypersensitive C-reactive protein(hs-CRP) and procalcitonin(PCT) were measured in the three groups. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) was performed. The correlation between initial glucose level and the above indicators were compared among the three groups, and their predictive value for outcome in these patients was analyzed via receiver operating characteristic(ROC) curve.Results: In group C, the GLUave, GLUsd, GLUcv and PCT levels were significantly higher than those of the group A and B(P<0.05). There were no statistical differences in GLUave, GLUsd, GLUcv and PCT level between group A and B(P>0.05). There was no statistical difference in hs-CRP and APACHEⅡ among the three groups. The area under curve(AUC) of APACHEⅡ was 0.803, and AUC of PCT, hs-CRP, GLUcv, Glusd and GLUave were 0.756, 0.711, 0.660, 0.565 and 0.570, respectively.Conclusion: For the respiratory critical ill patients, the glucose variability and inflammatory markers are closely related to the initial glucose level within the first 24 hours. It also shows that the patients whose initial glucose level is higher than 10 mmol·L-1 may have higher glucose variability, severer inflammatory reaction and poorer prognosis. Among the indicators, APACHEⅡ score shows the highest predictive value, and the predictive value of the inflammatory markers PCT and hs-CRP is higher than that of GLUcv, GLUsd and GLUave.

参考文献:

[1] HERMANIDES J,VRIESENDORP T M,BOSMAN R J,et al.Glucose variability is associated with intensive care unit mortality[J].Crit Care Med,2010,38(3):838-842.
[2] 韩旭东,黄晓英,葛志华,等.脓毒症患者血糖变异度与预后相关性研究[J].中华危重症医学杂志:电子版,2011,4(3):168-172.
[3] 董裕康,梁显泉,虞晓红,等.严重多发伤患者早期血糖变异度与预后的相关性研究[J].临床急诊杂志,2015,16(10):764-767.
[4] ZUO Y Y,KANG Y,YIN W H,et al.The association of mean glucose level and glucose variability with intensive care unit mortality in patients with severe acute pancreatitis[J].J Crit Care,2012,27:146-152.
[5] 陈朝彦,罗佐杰,秦映芬,等.血糖变异度与重症监护病房患者预后的相关性[J].中国糖尿病杂志,2014,22(3):243-245.
[6] 中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):241-242.
[7] 中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].中华结核和呼吸杂志,1999,22(4):201-203.
[8] AMIR Q,LINDA L H,ROGER C,et al.Use of intensive therapy for the management of glycemic in hospitalized patients:a clinical practice guideline from the American College of Physicians[J].Ann Intern Med,2011(154):260-267.
[9] 于凯江,管向东,严静,等.中国重症医学专科资质培训教材[M].2版.北京:人民卫生出版社,2016:341-342.
[10] 陈炎堂,赵英萍,杜云波,等.血清降钙素原、C-反应蛋白及白介素6在重症肺炎患者中的临床应用[J].中华临床医师杂志:电子版,2012,6(15):4336-4340.
[11] 钱靖,陈一强,孔晋亮,等.重症肺炎病原学特征及其耐药情况分析[J].中国现代医药杂志,2015,17(2):1-4.
[12] 郭霞,喻昌利,安庆丽,等.老年重症肺炎患者病原学分布及预后危险因素分析[J].广东医学,2016,37(6):873-875.
[13] 降钙素原急诊临床应用专家共识组.降钙素原(PCT)急诊临床应用的专家共识[J].中华急诊医学杂志,2012,21(9):944-951.
[14] MEISNER M,TSCHAIKOWSKY K,PALMAERS T,et al.Comparison of procalcitonin(PCT) and C-reactive protein(CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS[J].Crit Care,1999,3(1):45-55.
[15] 马晓春.应提高脓毒症对肝损伤的认识[J].中华危重病急救医学,2013,25(4):198-200.
[16] 王婴云,周承惇,陶珍,等.血糖变异度与呼吸危重症患者预后关系研究[J].临床医学工程,2014,21(11):1424-1426.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 187076 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364