脓毒症患者血糖变异度与预后的相关性研究

Relation of glucose variability to prognosis in patients with sepsis

目的探讨脓毒症患者血糖变异度与预后的相关性。方法选择2008年5月至2011年3月入住我院重症监护病房的167例脓毒症患者。统计每例患者的血糖值(GLU),计算平均血糖水平(GLUav)e及标准差(GLUsd),血糖变异系数(GLUc)v,以GLUsd和GLUcv反应血糖变异度,同时记录每例患者的血糖最高值(GLUma)x、最低值(GLUmin)和两者的差值(GLUdi)f。按预后分为存活组(106例)和死亡组(61例),比较两组年龄、感染相关器官功能衰竭评分系统(SOFA)评分、急性病生理学和长期健康评价(APACHE)Ⅱ评分以及GLUave,GLUsd,GLUcv,GLUmax,GLUmin,GLUdif。应用受试者工作特征(ROC)曲线分别对APACHEⅡ,SOFA评分以及GLUsd和GLUcv在预测病死率上的应用价值进行评价。结果存活组和死亡组年龄,GLUave,GLUmax,GLUmin,GLUdif均没有明显差异(P均>0.05),死亡组APACHEⅡ、SOFA评分,GLUsd和GLUcv均明显高于存活组(P均<0.01)。ROC曲线显示,GLUcv预测病死率敏感性最高。结论脓毒症血糖变异度与病死率存在显著相关性,高血糖变异度是病死率增加的重要因素。

Objective To investigate the relation of glucose variability to prognosis in patients with sepsis. Methods One hundred and sixty-seven patients with sepsis admitted to our intensive care unite from May 2008 to March 2011 were enrolled in our study. The blood glucose concentration （GLU）, the mean and standard deviation of GLU （GLUave and GLUsd）, coefficient of GLU variability （GLUcv） of each patient were recorded and calculated. The GLUsd and GLUcv were used as measures of glucose variability. The maximum and the minimum GLU （GLUmax and GLUmin） and differential values of GLU （GLUer） were also recorded and compared. The patients were divided into two groups： survival group （106 cases） and death group （61 cases） according to the prognosis. The age, sequential organ failure assessment （SOFA） score, acute physiology and chronic health evaluation （APACHE） Ⅱ score, GLU GLUsd, GLUcv, GLUmax, GLUmin, and GLUdif of each group were compared. The value of predicting mortality of APACHE Ⅱ score, SOFA score, GLUsd and GLUcv were evaluated by receiver operating characteristic （ROC） curve respectively. Results There was no statistically difference in the age, GLUave, GLUmax, GLUmin, and GLUdif, between the two groups （all P〉0.05）. The APACHE Ⅱ score, SOFA score, GLUsd and GLUcv in the death group were higher than the survival group （all P〈0.01）. ROC curve indicated that GLUcv could sensitively predict mortality. Conclusion Glucose variability is firmly associated with mortality in patients with sepsis, and the high glucose variability played an important role in increasing the mortality.