呼吸危重症患者血糖水平与炎症指标的相关性研究-东南大学学报医学版

呼吸危重症患者血糖水平与炎症指标的相关性研究

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

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.

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