糖化血红蛋白和血糖水平对全身炎症反应综合征患者预后的影响

The Clinical Study on the Effect of Glycosylated Hemoglobin and Blood Glucose on Prognosis of Patients with Severe Inflammatory Response Syndrome

目的探讨糖化血红蛋白和血糖水平对全身炎症反应综合征(SIRS)患者预后的影响。方法 SIRS患者74例,按有无糖尿病分为糖尿病组(A组)和应激性高血糖组(B组);将A组分为糖化血红蛋白>6.5%组(A1组)和糖化血红蛋白≤6.5%组(A2组);将B组分为血糖≥11.1 mmol/L组(B1组)和血糖<11.1 mmol/L组(B2组)。比较入院时血糖和糖化血红蛋白水平、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、28 d病死率及院内感染发生率。结果 A组入院时糖化血红蛋白水平较B组明显升高,差异有统计学意义(P<0.05);A组28 d病死率较B组明显降低,差异有统计学意义(P<0.05)。A1组入院时血糖水平、APACHEⅡ评分、28 d病死率及院内感染发生率较A2组明显升高,差异均有统计学意义(P<0.05)。B1组入院时糖化血红蛋白水平及院内感染发生率较B2组明显升高,差异均有统计学意义(P<0.05)。结论 SIRS患者入院时血糖、糖化血红蛋白水平越高,病情越重,预后越差。对于SIRS患者应动态检测血糖、糖化血红蛋白水平变化,适当控制血糖。

Objective To investigate the effect of blood glucose and glycosylated hemoglobin on the prognosis of patients with severe inflammatory response syndrome.Methods According to having or not having diabetes mellitus,seventy-four SIRS patients were divided into diabetes group（A group） and stress-induced hyperglycemia group（B group）;group A was further divided into glycosylated hemoglobin6.5% group（A1 group） and glycosylated hemoglobin ≤6.5% group（A2 group）;group B was further divided into blood glucose≥11.1mmol/L group（B1 group） and blood glucose11.1 mmol/L group（B2 group）.On admission blood glucose,glycosylated hemoglobin,APACHE Ⅱ score,hospital mortality over 28 days and the incidence of nosocomial infections were compared in each group.Results The level of glycosylated hemoglobin on admission was significantly higher in group A than in group B,the difference was statistical（P0.05）;The mortality over 28d was significantly reduced in group A than in group B,the difference was statistical（P0.05）.The on admission blood glucose,APACHE Ⅱ score,mortality over 28d and the incidence of nosocomial infections of group A1 was significantly higher than those of group A2,the difference was statistical（P0.05）.The on admission glycosylated hemoglobin and the incidence of nosocomial infections of group B1 was significantly higher than those of group B2,the difference was statistical（P0.05）.Conclusion The higher the levels of on admission blood glucose and glycosylated hemoglobin are,the more severe the disease is,and the worse the prognosis will be.The changes of blood glucose and glycosylated hemoglobin in SIRS patients should be tested dynamically and the blood glucose should be controlled in some degree.