SARS合并糖尿病死亡原因分析

Causes of death in SARS patients with diabetes mellitus

目的 :研究SARS合并糖尿病死亡原因。方法 :以我院 2 0 0 3年 4～ 6月收治的SARS合并糖尿病的 4 6例患者为研究对象 ,分为死亡组 (A组 )及治愈组 (B组 )。比较两组的生化指标、血氧饱和度 (SpO2 )、胸片、多器官功能衰竭 (MODS)、二重感染、激素用量、血常规以及CD3+ ,CD4 + ,CD8+ T淋巴细胞计数等。结果 :①A组丙氨酸转氨酶(ALT) ,尿素氮 (BUN) ,血清肌酸激酶 (CK) ,乳酸脱氢酶 (LDH)显著高于B组 (P <0 .0 1)。②A组SpO2 <95 % ,合并MODS ,二重感染及糖皮质激素日均用量≥ 16 0mg/d的例数均明显多于B组 (P <0 .0 5 )。③A组血小板 ,淋巴细胞 ,CD3+ ,CD4 + ,CD8+ T淋巴细胞计数显著低于B组 (P分别 <0 .0 1,0 .0 5 ,0 .0 0 1)。结论 :SARS合并糖尿病患者的死亡原因与肺损害、低氧血症、MODS、二重感染及激素用量密切相关。

Objective: To study the causes of death in SARS patients with diabetes mellitus. Methods: Among the patients with SARS admitted to Xuanwu Hospital from April, 2003 to June, 2003, 46 patients complicated with diabetes mellitus were divided into the fatal group(group A) and the recovery group (group B). The comparison was made between the two groups, including the biochemical examinations, blood O 2 saturation(SpO 2), chest radiograph, multiple organ dysfunction syndrome(MODS), double infection, dose of the corticosteroid used, routine blood examination, CD3 +,CD4 +,CD8 + T cell counts, etc. Results: ①The ALT, BUN, CK and LDH in group A were significantly higher than those in group B(P<0.01). ②Compared with group B, the number of cases with SpO 2<95%, MODS, double infection and average daily dosage of corticosteroid≥160 mg in group A was obviously increased (P<0.05)。 ③In comparison with group B, the counts of the platelet, lymphocyte, CD3 +,CD4 +,CD8 + T cell in group A were decreased notably(P<0.01,P<0.05,P<0.001, respectively). ④The logistic regression analysis indicated that the LDH was significantly correlated with the causes of death in SARS patients with diabetes mellitus(r= 0.3596 , P=0.0017). Conclusion: The causes of death in SARS patients with diabetes mellitus are closely associated with the pulmonary lesion, hypoxemia, MODS, double infection and the dose of corticosteroid.