危重患者血糖波动与血清炎症因子水平及病情预后的相关性

Prognostic significance of glucose fluctuation and inflammatory factors in critically ill patients

目的探讨重症监护病房（ICU）危重患者的血糖波动与血清炎症因子c反应蛋白（CRP）、肿瘤坏死因子-α．（TNF-d）、白细胞介素-6（IL-6）和患者病情及预后的相关性。方法选择2010年1月至2011年1月入住北京军区总医院ICU病房的非糖尿病危重患者共60例，其中男38例、女22例，平均年龄（55±9）岁，急性生理学及慢性健康状况评估Ⅱ（APACHEII）评分〉10分，符合应激性高血糖诊断且糖化血红蛋白为4％-6％。患者入科12h内佩戴动态血糖监测系统（CGMS），监测平均血糖波动幅度（MAGE），测定空腹血清CRP、TNF．0l和IL-6水平，分析MAGE与炎症因子水平变化及与APACHEⅡ评分的关系；追踪观察患者28d预后。组间比较采用t检验。结果Pearson相关分析显示危重患者入科24h内MAGE与炎症因子CRP、TNF-d、IL-6及APACHERⅡ评分显著相关（r=0．622、0．505、0．509、0．597，均P〈0．01）。多元线性回归分析结果显示，MAGE和IL-6及性别对ICU患者APACHERlI评分的影响作用较大（β=0．155、0．768、-0．209，t=2．879、8．375、-3．170，均P〈0．05）。死亡病例MAGE及APACHEII评分均明显高于存活病例[MAGE分别为（3．34-1．0）、（5．1±2．0）mmol／L，APACHEⅡ分别为（21±3）、（26±5）分，均P〈0．01）]。多元logistic回归分析显示，MAGE可影响患者预后（OR=4．401，95％CI：2．185-6．618，P〈0．05）。结论危重患者血糖波动幅度与血清炎症因子水平及病重程度密切相关；血糖变异度高可作为ICU危重患者预后的独立预测因子。

Objective To investigate the relationship among mean amplitude of glycemic excursions （MAGE） , inflammatory factors （ C-reactive protein （CRP） , tumor necrosis factor-α （ TNF-α ） , interleukin-6 （IL-b）） and prognosis in critically ill patients in Intensive Care Unit （ICU）. Methods The study included 60 subjects （38 male subjects and 22 female subjects, mean age was 55 years, 2 subjects withdrew） ,and they were admitted to ICU between January 2010 and January 2011, with acute physiology and chronic health evaluation Ⅱ （APACHE U ） scores over 10, stress hyperglycemia, non-diabetic history and glycated hemoglobin（HbAlc） between 4% and 6%. The subjects were taken monitor MAGE by continuous glucose monitoring system （CGMS） for 12 hours after admission, and measured serum levels of CRP, TNF-α and IL-6, and the prognosis was observed 28 days later. Analyze the relationship among MAGE, inflammatory factors and APACHE Ⅱ scores. The data was compared between the two groups by using t test. Results Pearson correlation analysis showed that 24 hours after admission MAGE correlated closely with CRP, TNF-α, IL-6 and APACHE Ⅱ （ r = 0. 622,0. 505,0. 509,0. 597 ;P 〈 0. 01 ）. Multivariate linear regression analysis suggested MAGE and IL-6 played more important roles in APACHE Ⅱ scores （ P 〈 0. 05 ）. Compared with survivors, subjects who died at the end of our study had much higher levels of MAGE and APACHE Ⅱ （ P 〈 0. 01 ）. Logistic regression analysis indicated that MAGE correlated with patients＇ motality （ OR = 4. 401,95% CI： 2. 185-6. 618, P 〈 0. 05）. Conclusions MAGE is closely associated with serum inflammatory factors and critically ill patients＇ condition; （2）MAGE was an independent predictor in the prognosis of patients in ICU.