利用实时动态血糖检测系统评价慢重症患者血糖变异性与生存预后的相关性研究

The Correlation Between Serum Glucose Variability and Prognosis in Patients with Chronic Critical Illness by Continuous Glucose Monitoring System

目的利用实时动态血糖检测系统(continuous glucose monitoring system,CGMS)评价慢重症(chronic critical illness,CCI)患者血糖变异性与生存预后的相关性。方法连续性纳入2014年1月至2016年11月江苏省中医院重症医学科收治的CCI患者共34例,分为存活组(n=14)和死亡组(n=20)。通过CGMS对CCI患者连续72h血糖监测,记录约288个血糖值,作出血糖值图,并计算平均血糖(MBG)、动态平均血糖标准差(SDBG)、平均血糖波动幅度(MAGE)和日间血糖平均绝对差(MODD)等血糖波动评价指数。结果存活组CCI患者SDBG、MAGE和MODD水平明显低于死亡组CCI患者(P<0.05)。ROC曲线分析提示,SDBG(AUC=0.828;95%CI:0.759,0.867;cut-off值为3.92mmol/L;敏感性为83.1%;特异性为86.6%)和MAGE(AUC=0.804;95%CI:0.716,0.839;cut-off值为6.14mmol/L;敏感性为81.5%;特异性为79.8%)诊断价值最高。相关性分析提示,SDBG(r=0.664,P<0.05)和MAGE(r=0.623,P<0.05)水平与CCI患者死亡事件呈正相关。Logistic回归分析提示,SDBG(>3.92mmol/L)(P<0.05)和MAGE(>6.14mmol/L)(P<0.05)为CCI患者死亡事件的独立危险因素。结论血糖波动指数(SDBG和MAGE)有助于预判CCI患者的临床预后。

Objective To evaluate the correlation between serum glucose variability and prognosis in patients with chronic critical illness(CCI)by using continuous glucose monitoring system(CGMS).Methods Thirty-four CCI patients admitted into Jiangsu Province Hospital of TCM from January of 2014 to November of 2016 were enrolled in this study and divided into the survival group(n=14)and the death group(n=20).CGMS was used to monitor the serum glucose of those patients for 72 hours continuously and about 288 readings of serum glucose were recorded to demonstrate the map of serum glucose value and calculate the glucose variability indexes such as MBG,SDBG,MAGE and MODD.Results The levels of SDBG,MAGE and MODD in the survival group were significantly lower than those in the death group(P<0.05).The results of ROC analysis showed that SDBG(AUC=0.828,95%CI:0.759~0.867,Cut-off value:3.92 mmol/L,Sensitivity:83.1%,Specificity:86.6%)and MAGE(AUC=0.804,95%CI:0.716~0.839,Cut-off value:6.14 mmol/L,Sensitivity:81.5%,Specificity;79.8%)have the best diagnostic value.The results of the correlation analysis showed that both SDBG and MAGE were positively correlated with the mortality of CCI patients respectively(r=0.664,P<0.05;r=0.623,P<0.05).The results of Logistic regression analysis showed SDBG(>3.92 mmol/L)(OR=1.88,95%CI:1.11~2.36,P<0.05)and MAGE(>6.14 mmol/L)(OR=1.65,95%CI:1.02~2.15,P<0.05)were the independent risk factors for the mortality of CCI patients.Conclusion The glucose variability indexes including SDBG and MAGE are helpful in predicting the clinical prognosis of CCI patients by using CGMS.