血糖波动与危重症患者预后相关性的临床研究

The association of glucose variability and mortality in critical ill patients

目的探讨平均血糖和血糖波动与重症监护病房(ICU)危重症患者预后的相关性。方法回顾性分析2009年1月至2010年12月入重症监护病房且期间测血糖不少于10次的184例ICU危重症患者的病例资料,根据预后情况分为死亡组(n=63)与存活组(n=121),比较两组间初始血糖(GluAdm)、平均血糖(GluMV)、血糖标准差(GluSD)、血糖变异系数(GluCV)的差异,应用受试者工作特征曲线(ROC曲线)评价GluAdm、GluMV、GluSD、GluCV与ICU患者病死率相关性。结果死亡组患者GluAdm、GluSD及GluCV均明显高于存活组[GluAdm(10.2±4.7)mmol/Lvs.(9.6±3.0)mmol/L,GluSD(3.61±1.68)mmol/Lvs.(2.52±0.84)mmol/L,GluCV0.328±0.120vs.0.245±0.061,P均<0.05],GluMV在存活组与死亡组间无统计学差异。GluCV的ROC曲线下面积(AUC)为0.710±0.044,明显高于GluSD、GluAdm、GluMV的AUC(分别为0.692±0.045、0.570±0.046和0.506±0.047,P均<0.05)。结论危重症患者血糖波动与病死率密切相关,GluCV较GluSD、GluAdm、GluMV对重症患者住院期间死亡的预测更为精确。

Objective To determine the correlation between glucose variability and mortality in critical ill patients.Methods A retrospective study involving 184 patients admitted to department of general intensive care unit(ICU)in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2010,for whom at least 10 glucose measurements were available.According to the patients'prognosis,critically ill patients were divided into nonsurvivors(63 cases)and survivors(121 cases),monitored in terms of their initial blood glucose(GluAdm),the mean blood glucose value(GluMV),standard deviation of blood glucose(GluSD),coefficient of variation glucose(GluCV).Then GluAdm,GluMV,GluSD and GluCV were compared between survivors and nonsurvivors,and the receiver operating characteristic curve(ROC curve)was applied to evaluate the association between blood glucose variability and prognosis.Results The levels of GluAdm,GluSD and GluCV of nonsurvivors were higher than those of survivors[GluAdm:(10.2±4.7)mmol/L vs.(9.6±3.0)mmol/L,GluSD:(3.61±1.68)mmol/L vs.(2.52±0.84)mmol/L,GluCV:0.328±0.120 vs.0.245±0.061,all P<0.05],but no significant difference in the levels of GluMV.When ROC was applied,and the area under the curve (AUC)of GluCV were 0.710±0.044,which was higher than that of GluSD,GluAdm and GluMV(0.692±0.045,0.570±0.046 and 0.506±0.047,all P<0.05).Conclusions Glucose variability is closely related with the mortality in critical ill patients,and GluCV is more valuable in predicting ICU mortality than GluAdm,GluMV and GluSD.