糖尿病合并重症肺炎患者血常规、HbA1c、PCT、hs-CRP水平变化及与预后的相关性

Correlation between changes of blood routine,HbA1c,PCT,hs-CRP levels and prognosis in patients with diabetes complicating severe pneumonia

目的分析糖尿病合并重症肺炎患者血常规、糖化血红蛋白(HbA1c)、降钙素原(PCT)、高敏C反应蛋白(hs-CRP)水平变化及与预后的相关性。方法选取2017年4月至2019年2月该院收治的92例糖尿病合并肺炎患者,其中非重症肺炎30例(非重症组),重症肺炎62例(重症组),比较两组患者及重症组中存活者、病死者的血常规[血红蛋白(Hb)、白细胞计数(WBC)、中性粒细胞百分比(NEUT)、血小板计数(PLT)、淋巴细胞绝对值(LYM#)、嗜酸性粒细胞百分比(EO)]、HbA1c、PCT、hs-CRP水平,采用多因素Logistic回归分析影响患者预后的因素,应用受试者工作特征(ROC)曲线分析各指标对预后的预测价值。结果(1)重症组WBC、NEUT、HbA1c、PCT、hs-CRP水平高于非重症组,LYM#低于非重症组(P<0.05)。(2)治疗前病死者NEUT、HbA1c、PCT、hs-CRP水平高于存活者,LYM#低于存活者(P<0.05);与治疗前比较,存活者治疗1、3 d后WBC、NEUT、HbA1c、PCT、hs-CRP水平均降低(P<0.05);病死者治疗前,治疗1、3 d后WBC、NEUT、HbA1c、PCT、hs-CRP水平比较,差异无统计学意义(P>0.05)。(3)NEUT、HbA1c、PCT、hs-CRP是影响预后的独立危险因素(P<0.05)。(4)在预测价值方面,治疗1 d后PCT的ROC曲线下面积(AUC)最大,其次是hs-CRP、HbA1c、NEUT,治疗3 d后的AUC由大到小依次为hs-CRP、HbA1c、PCT、NEUT。结论糖尿病合并重症肺炎患者WBC、NEUT、HbA1c、PCT、hs-CRP存在明显异常,NEUT、HbA1c、PCT、hs-CRP水平与预后相关。

Objective To analyze the changes of blood routine,HbA1c,PCT,hs-CRP levels in the patients with diabetes complicating severe pneumonia and their correlation with prognosis.Methods A total of 92 inpatients with diabetes mellitus(DM)complicating pneumonia in this hospital from April 2017 to February 2019 were selected,including 30 cases of non-severe pneumonia(non-severe group)and 62 cases of severe pneumonia(severe group).Blood routine(Hb,WBC,NEUT,PLT,LYM#,EO),saccharification hemoglobin(HbA1c),procalcitonin(PCT),and high-sensitivity C-reactive protein(hs-CRP)levels were compared between the two groups and between the survival cases and death cases of the severe group.The Logistic multiple factors regression was adopted to analyze the factors affecting the prognosis.The receiver operating characteristic(ROC)curve was adopted to analyze the predictive value of each indicator to the prediction.Results(1)The levels of WBC,NEUT,HbA1c,PCT,hs-CRP in the severe group were higher than those in the non-severe group,LYM#was lower than that in the non-severe group(P<0.05).(2)The levels of NEUT,HbA1c,PCT and hs-CRP before treatment in death cases were higher than those in the survivors,LYM#was lower than that in the survivors(P<0.05);Compared with the levels of WBC,NEUT,HbA1c,PCT and hs-CRP before treatment,the levels of WBC,NEUT,HbA1c,PCT and hs-CRP were decreased on 1,3 d after treatment in the survivors(P<0.05);which had no statistical differences between before treatment and on 1,3 d after treatment in death cases(P>0.05).(3)NEUT,HbA1c,PCT and hs-CRP were the independent risk factors affecting the prognosis(P<0.05).(4)In the aspect of predictive value,the area under the ROC curve of PCT was maximal,followed by hs-CRP,HbA1c and NEUT in turn.AUC after 3 d treatment from large to small was hs-CRP,HbA1c,PCT and NEUT.Conclusion WBC,NEUT,HbA1c,PCT and hs-CRP have significant abnormalities in the patients with DM complicating severe pneumonia.The levels of NEUT,HbA1c,PCT and hs-CRP are correlated with prognosis.