血糖不稳定指数对胃癌术后应激性高血糖患者预后的预测价值

Value of glycemic lability index in predicion of nondiabetic patients with stress hyperglycemia after surgery for gastric cancer

目的探讨血糖不稳定指数(GLI)对胃癌术后应激性高血糖(SHG)患者预后的预测作用。方法对216例住院的非糖尿病胃癌手术患者术前、术日早晨、术后回室和术后第1,2,3天(每天4次)监测血糖相关指标。按住院期间是否出现并发症分为两组,比较相关指标的组间差异,分析SHG患者的血糖资料;绘制ROC曲线,分析GLI对患者预后的预测作用。结果216例非糖尿病患者中,71例(32.87%)出现SHG,其血糖在术后第3天基本恢复正常。两组患者入院血糖(BG_(Adm))、术后3d平均FBG(FBG_(Ave))和术后3d平均血糖(BG_(Ave))相仿(P>0.05);有并发症组中,SHG患者术后第1、2、3天GLI及3d总GLI均高于无并发症组(P<0.01)。术后第1、2、3天GLI及3d总GLI的ROC曲线下面积大于FBG_(Ave)和BG_(Ave)(P<0.01)。结论 GLI对胃癌术后SHG患者预后有一定预测价值。对非糖尿病胃癌手术患者营养支持期间至少应连续监测3d的血糖变化。

Objective To investigate the value of glycemic lability index（GLI） in the predicion of the prognosis in nondiabetic patients with stress hyperglycemia（SHG） after surgery for gastric cancer. Methods The blood glucose（BG）-related criteria were detected in 216 nondiabetic patients undergoing surgery for gastric cancer on admission,on operating day and on the 1st, 2nd and 3rd day after operation（every 6 hours per day）. On the basis of occurrence of postoperative complication, the patients were assigned into two groups of A（with postoperative complications） and B（without）. The differences in BCrrelated criteria between two groups were compared and the data of the patients with SHG were analyzed. The value of GLI in the predicion of nondiabetie patients with SHG after surgery was evaluated by drawing the curve of receiver-operating characteristics （ROC）. Results Of 216 nondiabetie patients, 71（32.87%） cases were with SHG, in whom BG recovered to normal on the 3rd day after surgery. There were no significant differences in plasma BG on admission and averaged FBG of three postoperative days between two groups（P〉0. 05）. But GLI of the 1st, 2na 3rd day and 72 hours after operation was higher in group A than that in group B（P〈0. 01）. The area under ROC curve for GLI of the 1st ,2nd 3ra day and 72 hours after operation was more than that for plasma BG on admission and averaged FBG （P〈0. 01 ）. Conclusion GLI has a certain value in the prognosis predicion of nondiabetic patients with SHG after surgery for gastric cancer, in whom a dynamic monitoring of BG within three postoperative days is needed.