糖尿病合并肝脓肿患者HbA1C水平与超声引导穿刺干预效果的关系

The relationship between HbA1c level and the effect of ultrasound-guided puncture in patients with diabetes mellitus and liver abscess

目的研究糖尿病合并肝脓肿患者糖化血红蛋白(HbA1c)水平和超声引导穿刺干预效果的关系。方法2018年1月至2019年12月蚌埠市第三人民医院收治的56例糖尿病合并肝脓肿患者,所有患者均在超声引导下行经皮穿刺置管引流术(PCD)。根据HbA1c控制效果将56例患者分为控制良好组(HbA1c<7%)、控制一般组(7%≤HbA1c≤9%)和控制差组(HbA1c>9%)。比较3组患者临床疗效和并发症发生率。采用多因素Logistic回归分析HbA1c控制效果的影响因素。结果56例患者中控制良好组20例,控制一般组和控制差组各18例。55例获得临床恢复。3组临床康复时间分别为(13.2±6.9)d、(18.7±7.4)d、(22.0±9.3)d,差异有统计学意义(t=3.282,P=0.002)。HbA1c与临床恢复时间呈显著负相关性(r=-0.519,P<0.01)。术后1周和2周时控制良好组临床疗效显著优于其他两组(P<0.05)。控制良好组腹水、胸腔积液、腹腔积液及急性肾衰竭发生率均显著低于控制差组,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示肾功能不全、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、尿微量蛋白(mAlb)及血尿酸(SUA)是HbA1c的独立影响因素。结论糖尿病合并肝脓肿患者HbA1C与超声引导下PCD效果密切相关,HbA1c水平受SUA、血糖及肾功能影响,临床应引起重视。

Objective To study the relationship between glycosylated hemoglobin(HbA1c)level and the effect of ultrasound-guided puncture in patients with diabetes mellitus(DM)and liver abscess(LA).Methods Fifty-six patients with DM and LA were treated in our hospital from January 2018 to December 2019.All patients were treated by percutaneous catheter drainage(PCD)under the guidance of ultrasound.The 56 patients were divided into good control group(HbA1c<7%),general control group(7%<HbA1c≤9%)and poor control group(HbA1c>9%)according to the level of HbA1c.The clinical effect and complication rate of the 3 groups were compared.The Logistic regression analysis was used to analyze the influence factors of HbA1c.Results There were 20,18 and 18 cases in good control group,general control group and poor control group,respectively.Fifty-five patients got the clinical recovery.There was a significant difference in clinical rehabilitation time among the 3 groups(P<0.05).The HbA1c was negatively correlated with clinical rehabilitation time(r=-0.519,P=0.000).The clinical effect in the good control group at 1 and 2 weeks after operation was better than that of the other 2 groups(P<0.05).The incidence rate of ascites,pleural effusion and acute renal failure in the good control group were significantly lower than those in the poor control group(P<0.05).The Logistic regression analysis showed that the renal insufficiency,fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h PG),urinary microalbumin(mAlb)and blood uric acid(SUA)were the independent influence factors for HbA1c.Conclusion The level of HbA1c in patients with DM and LA is closely related to the effect of ultrasound-guided PCD.The HbA1c level can be affected by SUA,blood glucose and renal function,which should be paid more attention in clinical practice.