住院患者入院时血糖水平与医疗费用、疾病预后的相关研究

Relationships of admission hyperglycemia with medical cost and disease prognosis in hospitalized patients

目的探讨住院患者人院时不同血糖水平与住院时间、医疗费用及疾病预后的关系。方法选取2009年11月至2011年7月期间人院的4868例患者，按入院24h内测得的血糖水平分为非高血糖组3429例、高血糖组1439例，后者包括糖尿病和应激性高血糖患者；根据患者年龄分为非老年组（年龄〈60岁）2532例和老年组（年龄≥60岁）2336例；其中278例冠心病患者再分为高血糖组120例和非高血糖组158例。各组间进行有关数据比较。结果高血糖组患者的住院天数、医疗费用和总病死率均显著高于非高血糖组（中位数住院日：15vs10d，P〈0．01；中位数医疗费用：14064．7vs8980．9元，P〈0．01；死亡率：2．92％vs0．61％，P〈0．01）。按年龄分组后，无论是非老年组还是老年组中糖尿病和应激性高血糖患者的医疗费用均明显高于非高血糖患者，住院日明显延长；应激性高血糖患者的医疗费用明显高于糖尿病患者；非老年组中应激性高血糖患者的死亡率明显高于非高血糖患者，但与糖尿病患者相比无明显差异，老年组糖尿病和应激性高血糖患者的死亡率无明显差异，但均明显高于非高血糖患者。冠心病患者中糖尿病和应激性高血糖患者与非高血糖患者的年龄无明显差异，前两组的医疗费用明显高于非高血糖组，住院日更长（分别为14，15和12d）、死亡率更高（分别为6．41％，7．14％和0．63％）。结论入院时高血糖水平预示患者有更高的医疗花费、更长的住院时间和更高的死亡率。

Objective To analyze the relationships of different blood glucose levels with medical cost, hospitalization time and disease prognosis in hospitalized patients. Methods Totally 4868 patients were checked for their blood glucose immediately after admission into hospital （not over 24 hours ） and then divided into groups： non-hyperglycemia group（3429 cases） and hyperglycemia group（1439 cases） which included the patients with diabetes or with stress hyperglycemia （patients with hyperglycemia, without diabetes history and/or with normal HbAlc level, normal glucose level during follow-up in hospital）. The patients were also divided into younger group （n=2532, age 〈 60yrs） and older group （n=2336, age≥60 yrs）. Totally 278 patients with coronary heart disease were further divided into hyperglycemia group （120 cases） and non-hyperglycemia group （158 cases）. The hospitalization time, medical cost and diseases prognosis were compared between groups. Results There were 29.5% of these patients with hyperglycemia, including 11.4% with stress hyperglycemia. Patients with hyperglycemia had significant longer hospitalization （median： 15 vs 10d, P 〈 0.01）, higher medical cost （median： 14064.7 vs. 8980.9 Yuan RMB, P 〈 0.01） and higher mortality in hospital （2.92% vs 0.61%, P 〈 0.01）. The mortality of patients with stress hyperglycemia was significantly higher than patients without hyperglycemia, but no significant difference was found compared with patients with diabetes in younger group. There was no significant difference in the mortality between the elderly patients with diabetes and stress hyperglycemia, but were both significantly higher than patients without hyperglycemia. No statistical difference of the age was found among the diabetes, stress hyperglycemic and non-hyperglycemic patients with coronary heart disease. Patients with diabetes or hyperglycemia had significant longer hospital stay, higher medical cost and higher mortality. Conclusion The patients with admission hyperglycemia have significant higher medical cost and poor prognosis.