术后早期血糖异常对食管癌根治术患者短期预后的预测价值

The value of abnormal early postoperative blood glucose concentration in predicting the short-term outcome of patients after radical resection of esophageal cancer

目的分析食管癌根治术后早期血糖异常对术后短期预后的评估价值。方法回顾性研究复旦大学附属中山医院2015年4月至2017年9月的308例食管癌根治术患者的住院病例,收集人口学特征、术前已知的夹杂症、术前空腹血糖、术后早期血糖值及术后住院期间的短期临床不良事件等数据。308例中1例术后早期发生低血糖(3.8 mmol/L),未单独成组。307例患者按术后早期血糖分为正常血糖组(n=215)和高血糖组(n=92)。另以术前的空腹血糖为基础血糖,分为术后血糖升高较多组(≥4 mmol/L,n=52)及血糖升高较少组(<4 mmol/L,n=255)。结果采用分层χ^2检验进行术后早期高血糖与各术后临床不良事件的风险评估,差异无统计学意义。多元Logistics回归处理混杂因素后发现,血糖波动大是术后不良事件总发生率的危险因素(P=0.003,OR=2.641,95%CI:1.402~4.976),血糖波动大亦是病死率的危险因素(P=0.012,OR=7.539,95%CI:11.534~36.713)。结论术后早期血糖较术前空腹血糖波动较大可以预测食管癌根治术后短期预后不良。

Objective To analyze the relationship between the short-term outcomes and abnormal early postoperative blood glucose concentration of patients after radical resection of esophageal cancer.Methods We conducted a retrospective cohort analysis of 308 patients who underwent radical resection of esophageal cancer between Apr.2015 and Sep.2017 in Zhongshan Hospital,Fudan University.These materials were including demographic characteristics,known preoperatively previous medical history(PMH),fasting blood glucose before operation,early postoperative blood glucose concentration and shortterm clinical adverse events during hospitalization.Among the 308 cases,1 patient developed hypoglycemia(3.8 mmol/L),which was not isolated into a group.The other 307 patients were divided into two groups according to the early postoperative blood glucose values:normal blood glucose group(n=215)and hyperglycemia group(n=92).In addition,based on the fasting blood glucose before operation,the patients were divided into the group with higher postoperative blood glucose fluctuation(≥4 mmol/L,n=52)and the group with lower blood glucose fluctuation(<4 mmol/L,n=255).Results No statistical difference was found between early postoperative hyperglycemia and postoperative adverse events by stratified Person Chi-Square test.Using multivariate Logistics regression to deal with confounding factors,the blood glucose fluctuation was a risk factor.The incidence of postoperative adverse events was higher in the higher glucose fluctuation group than that in the lower glucose fluctuation group using preoperative fasting blood glucose concentration as baseline(P=0.003,OR=2.641,95%CI:1.402-4.976).Mortality was higher in the higher glucose fluctuation group than in the lower glucose fluctuation groupusing preoperative fasting blood glucose as baseline(P=0.012,OR=7.539,95%CI:1.534-36.713).Conclusion Early high postoperative blood glucose fluctuation may be a predictorfor poor short-term outcomes of patients after radical resection of esophageal cancer.