糖代谢紊乱与重症肺炎合并脓毒症患者病情及预后的关系

Analysis of the relationship between glucose metabolism disorder and the condition and prognosis of patients with severe pneumonia complicated with sepsis

目的研究糖代谢紊乱与重症肺炎合并脓毒症患者病情及预后的相关性。方法选取2018年1月—2020年3月中国人民解放军空军军医大学第一附属医院收治重症肺炎患者157例,按病情分为肺炎组(89例)及重症肺炎合并脓毒症组(68例)。合并症组再分为轻度脓毒症亚组42例,严重脓毒症亚组12例,脓毒症休克亚组14例,以患者出院后3个月随访情况分为存活亚组49例与死亡亚组19例。记录患者住院期间空腹血糖、高血糖、低血糖、血糖差值、血糖平均值、糖化血红蛋白及血糖变异系数;Logistic回归分析影响重症肺炎合并脓毒症患者预后的因素。结果合并症组高血压、糖尿病患者比例均高于肺炎组(χ^(2)/P=4.239/0.040、4.248/0.039),空腹血糖、高血糖、血糖差值、血糖平均值、糖化血红蛋白、血糖变异系数均高于肺炎组(t/P=8.715/0.000、9.238/0.000、14.497/0.000、5.437/0.000、17.927/0.000、15.262/0.000),而低血糖低于肺炎组(t/P=12.049/0.000)。空腹血糖、高血糖、血糖差值、糖化血红蛋白及血糖变异系数比较,脓毒症休克亚组>严重脓毒症亚组>轻度脓毒症亚组,低血糖比较,轻度脓毒症亚组>严重脓毒症亚组>脓毒症休克亚组,组内比较差异均有统计学意义(F/P=14.764/0.000、13.836/0.000、47.133/0.000、44.936/0.000、18.489/0.000、16.334/0.000)。死亡亚组空腹血糖、高血糖、血糖差值、血糖平均值、糖化血红蛋白及血糖变异系数均明显高于存活亚组(t/P=5.274/0.000、5.173/0.000、13.133/0.000、8.753/0.000、7.583/0.000、4.635/0.000),而死亡亚组患者低血糖明显低于存活亚组(t/P=6.799/0.000)。高血糖、低血糖、血糖差值、血糖平均值、糖化血红蛋白、血糖变异系数均是影响重症肺炎合并脓毒症患者预后的危险因素[OR(95%CI)=1.275(1.008~1.613)、1.516(1.198~1.917)、1.483(1.054~2.086)、1.756(1.215~2.538)、2.097(1.381~3.184)、1.936(1.210~3.099)]。结论重症肺炎合并脓毒症患者疾病严重程度越高,空腹血糖、高血糖、血糖差值、糖化血红蛋白及血糖变异系数越高,低血糖越低,糖代谢紊乱相关指标与患者预后有关。

Objective To study the correlation between glucose metabolism disorder and the severity and prognosis of severe pneumonia complicated with sepsis.Methods From January 2018 to March 2020,157 patients with severe pneumonia were treated in the First Affiliated Hospital of PLA Air Force Military Medical University.They were divided into pneumonia group(non sepsis patients,89 cases)and severe pneumonia combined with sepsis group(sepsis patients,68 cases).The sepsis group was further divided into 42 cases of mild sepsis subgroup,12 cases of severe sepsis subgroup,and 14 cases of septic shock subgroup,and the patients were divided into survival subgroup 49 cases and death subgroup 19 cases after 3 months follow-up.The fasting blood glucose,hyperglycemia,hypoglycemia,the difference of blood glucose,the mean blood glucose were recorded,glycosylated hemoglobin and coefficient of variation of blood glucose;and Logistic regression analysis of prognostic factors in patients with severe pneumonia complicated with sepsis.Results The proportion of patients with hypertension and diabetes mellitus in the complication group was higher than that in the pneumonia group(χ^(2)/P=4.239/0.040,4.248/0.039),fasting blood glucose,hyperglycemia,blood glucose difference,mean value of blood glucose,glycosylated hemoglobin and coefficient of variation of blood glucose were higher in the complication group than in the pneumonia group(t/P=8.715/0.000,9.238/0.000,14.497/0.000,5.437/0.000,17.927/0.000,15.262/0.000),while hypoglycemia was lower than that in pneumonia group Group(t/P=12.049/0.000).Fasting blood glucose,hyperglycemia,blood glucose difference,glycosylated hemoglobin and coefficient of variation of blood glucose from high to low were septic shock subgroup,severe sepsis subgroup and mild sepsis subgroup,and hypoglycemia from high to low were mild sepsis subgroup,severe sepsis subgroup and septic shock subgroup(F/P=14.764/0.000,13.836/0.000,47.133/0.000,44.936/0.000,18.489/0.000,16.334/0.000).Fasting blood glucose,hyperglycemia,blood glucose difference,mean blood glucose,glycosylated hemoglobin and coefficient of variation of blood glucose in death subgroup were significantly higher than those in survival subgroup(t/P=5.274/0.000,5.173/0.000,13.133/0.000,8.753/0.000,7.583/0.000,4.635/0.000),while hypoglycemia in death subgroup was significantly lower than that in survival subgroup(t/P=6.799/0.000).Hyperglycemia,hypoglycemia,blood glucose difference,mean value of blood glucose,glucose Glycosylated hemoglobin and coefficient of variation of blood glucose were the risk factors influencing the prognosis of patients with severe pneumonia complicated with sepsis[OR(95%CI)=1.275(1.008~1.613),1.516(1.198~1.917),1.483(1.054~2.086),1.756(1.215~2.538),2.097(1.381~3.184),1.936(1.210~3.099)].Conclusion Fasting blood glucose,hyperglycemia,blood glucose difference,glycosylated hemoglobin and coefficient of variation of blood glucose in patients with severe pneumonia complicated with sepsis increased with the severity of the disease,hypoglycemia decreased with the severity of the disease,the related indexes of glucose metabolism disorder are related to the prognosis of patients.