静脉血糖和糖化血红蛋白在健康体检者和急诊室及ICU3种不同人群中的分布差异

Distribution differences in venous blood glucose and hemoglobin Alc of patients in physical examination clinic, emergency room and intensive care unit

目的 比较静脉血糖（BG）、糖化血红蛋白（HbA1c）在健康体检者、急诊和重症加强治疗病房（ICU）患者中的分布差异,分析其临床特点,为临床诊疗提供参考依据.方法 分别采集门诊体检、急诊、ICU超过1年就诊患者的临床数据,分层比较其BG及HbA1c分布差异,并统计既往无糖尿病史的急重症患者就诊时BG异常的发生率以及潜在糖尿病的发生率.结果 收集ICU患者195例、急诊室患者349例、健康体检者2 474例.3种类型受试者性别比较差异无统计学意义,体检者年龄较ICU和急诊患者明显偏小（岁：44.84±12.65比61.93±18.29、67.51±17.12,均P＜0.05）,急诊患者平均年龄较ICU患者大（P＜0.05）.急诊患者中约1/3有糖尿病史,其比例明显高于ICU患者[38.1％ （133/349）比23.1％ （45/150）],ICU病死率明显高于急诊患者[18.5％ （36/195）比4.9％（17/349）,P＜0.05].ICU患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分为（12.05±7.76）分,ICU HbA1c＜6.5％和HbA1c≥6.5％者APACHEⅡ评分比较差异无统计学意义（分：11.3±0.7比13.3±1.7,P=0.290）.41.6％（89/214）无糖尿病史的急诊患者就诊时静脉BG≥7.8mmol/L,提示存在糖耐量异常,17.3％ （37/214）的患者HbA1c≥6.5％.无糖尿病史的ICU患者,入科随机BG检测有37.6％ （56/149）存在糖耐量异常（≥7.8 mmol/L）,6.7％的患者测HbA1c≥6.5％.结论 不同诊疗岗位受试者BG情况存在差异,急重症患者BG异常发病率高,隐匿性糖尿病发病率高.临床实践工作中需建立个体化的监测方案和诊疗流程,同时应构建系统性的糖尿病诊疗体系对患者进行综合管理.

Objective To compare the distribution differences in venous blood glucose （BG） and hemoglobin Alc （HbA l c） of patients in physical examination clinic, emergency room and intensive care unit （ICU） and analyze their clinical characteristics to provide a reference basis for clinical diagnosis and treatment. Methods The historical clinical data over one year were collected respectively from the physical examination clinic, emergency room and ICU, according to BG and HbAlc levels, the distribution differences in BG and HbAlc were compared and the prevalences of hyperglycemia and pre-diabetes in critically ill patients without the history of diabetes were calculated. Results ICU 195 patients, emergency room 349 patients and 2 474 patients from physical examination clinic were included in this study. No statistical significant difference of gender existed in the three groups, the patients from physical examination clinic were obviously younger than those from the other two groups respectively （44.84±12.65 vs. 61.93±18.29, 67.51±17.12, both P 〈 0.05）, and the mean age of patients from emergency room was older than that from ICU （P 〈 0.05）. About 1/3 of emergency patients had the history of diabetes, and this ratio was significantly higher than that in ICU patients [38.1% （133/349） to 23.1% （45/150）]. The mortality in ICU was markedly higher than that in emergency room [18.5% （36/195） vs. 4.9% （17/349）, P 〈 0.051. The acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ ） score in ICU patients was 12.05±7.76 and there was no significant difference in the APACHE II score between patients with HbAIc 〈 6.5% and HbAlc ≥6.5% （11.3±0.719 vs. 13.32±1.742, P = 0.290）. 41.6% （89/214） of emergency patients without diabetes history were considered glucose tolerance abnormality due to BG ≥ 7.8 mmol/L, and in 17.3% （37/214） of them HbAlc ≥6.5%. In ICU patients without diabetes history, on admission 37.6% （56/149） had glucose tolerance abnormality （ ≥7.8 mmol/L） and in 6.7% of them HbAlc ≥ 6.5% by random determination. Conclusions There is a distribution difference of BG among different working parts. The incidence of abnormal BG and occult diabetes in critically ill patients is high. In clinical practice, the establishment of individualized monitoring scheme and process of medical care is necessary. At the same time, a systematic comprehensive management plan should be set up for standard diagnosis and treatment of diabetes.