糖尿病合并肺部感染的危险因素、HbAlc、PCT水平变化及对患者预后转归的预测价值

A Study of Risk Factors of Diabetes Mellitus with Pulmonary Infection,Changes of Levels of HbAlc and PCT and Predictive Value on Prognostic Outcomes of Patients

目的分析糖尿病合并肺部感染的危险因素,并评估糖化血红蛋白(glycated hemoglobin,HbAlc)、降钙素原(procalcitonin,PCT)水平对患者预后转归的预测价值。方法回顾性分析2019年2月至2021年12月我院102例2型糖尿病(type 2 diabetes mellitus,T2DM)合并肺部感染患者(感染组)及94例未合并肺部感染T2DM患者(未感染组)临床资料,分析感染组病原菌分布情况,采用Logistic模型评估T2DM合并肺部感染的危险因素;并记录感染组治疗前后外周血HbAlc、PCT水平变化情况,根据治疗转归情况分为临床有效组及无效组,比较其治疗前外周血HbAlc、PCT水平差异,利用受试者工作特征曲线(ROC)分析治疗前外周血HbAlc、PCT及其联合检测对T2DM合并肺部感染患者预后转归的预测价值。结果102例T2DM合并肺部感染患者共检出69株病原菌,其中革兰阴性菌最多(65.22%),革兰阳性菌其次(33.33%),真菌最少(1.45%)。感染组及未感染组性别、甲状腺功能减退情况比较,差异无统计学意义(P>0.05);感染组年龄、T2DM病程、住院时间及高血压、冠心病、低蛋白血症、脑梗死发生率均高于未感染组(P<0.05),且年龄≥60岁、T2DM病程≥10年、高血压、冠心病、低蛋白血症、脑梗死均为影响T2DM合并肺部感染的危险因素(OR=2.487、1.654、1.411、1.458、1.353、1.322,P<0.05)。感染组治疗前外周血HbAlc、PCT水平明显高于治疗后水平(P<0.05)。102例感染组患者77例治愈,14例好转,共91例纳入临床有效组;11例无效,纳入无效组;临床有效组治疗前外周血HbAlc、PCT水平均低于无效组(P<0.05);且治疗前外周血HbAlc、PCT对T2DM合并肺部感染患者转归不良均有较高预测价值(AUC=0.864、0.896,P<0.05),其cut-off值为9.565%、2.270ng/mL,且两项联合检测预测价值最高(AUC=0.930,P<0.05)。结论对于年龄较高、病程较长及合并高血压、冠心病、低蛋白血症、脑梗死的T2DM患者,应警惕肺部感染,本院T2DM合并肺部感染者以革兰阴性菌感染居多,且外周血HbAlc、PCT与患者转归情况密切相关,可作为预测患者预后状况的临床指标。

Objective To analyze the risk factors of diabetes mellitus with pulmonary infection and evaluate the predictive value of glycated hemoglobin(HbAlc)and procalcitonin(PCT)on prognostic outcomes of patients.Methods The clinical data of 102 patients with type 2 diabetes mellitus(T2DM)complicated with pulmonary infection(infected group)and 94 T2DM patients without pulmonary infection(uninfected group)from February,2019 to December,2021 in our hospital were retrospectively analyzed.The distribution of pathogenic bacteria was analyzed in the infected group,and logistic model was used to evaluate the risk factors of T2DM with pulmonary infection.The levels of peripheral blood HBALC and PCT were recorded in the infected group before and after treatment,and the patients were divided into the clinically effective group and ineffective group according to the treatment outcomes.The levels of peripheral blood HbAlc and PCT were compared before treatment,and the receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of peripheral blood HbAlc and PCT before treatment and their combination on the prognostic outcomes of T2DM patients with pulmonary infection.Results A total of 69 pathogenic bacteria were detected among 102 patients with T2DM complicated with pulmonary infection,among which Gram-negative bacteria were the most(65.22%),Gram-positive bacteria were the second(33.33%)and fungi were the least(1.45%).There were no significant differences in gender and hypothyroidism between the infected group and uninfected group(P>0.05).Age,T2DM duration,hospital stay and incidence rates of hypertension,coronary heart disease,hypoproteinemia and cerebral infarction in the infected group were all higher than those in the uninfected group(P<0.05),and age≥60 years old,T2DM duration≥10 years,hypertension,coronary heart disease,hypoproteinemia and cerebral infarction were independent risk factors affecting T2DM with pulmonary infection(OR=2.487,1.654,1.411,1.458,1.353,1.322,P<0.05).The levels of peripheral blood HBALC and PCT in the infected group before treatment were significantly higher than those after treatment(P<0.05).There were 77 cured cases and 14 improved cases among 102 patients in the infected group,thus a total of 91 patients were included in the clinically effective group.11 ineffective cases were included in the ineffective group.The levels of peripheral blood HbAlc and PCT in the clinically effective group before treatment were lower than those in the ineffective group(P<0.05).Peripheral blood HbAlc and PCT before treatment had a high predictive value on poor outcomes of patients with T2DM complicated with pulmonary infection(AUC=0.864,0.896,P<0.05),and their cut-off values were 9.565%and 2.270 ng/mL,respectively.The combined detection of the two had the highest predictive value(AUC=0.930,P<0.05).Conclusion T2DM patients with older age,also with a longer course of disease,and hypertension,coronary heart disease,hypoproteinemia and cerebral infarction,should be alert to pulmonary infection.Most T2DM patients with pulmonary infection in our hospital are infected with Gram-negative bacteria.Moreover,peripheral blood HbAlc and PCT are closely related to the outcomes of patients and can be used as clinical indicators to predict the prognosis of patients.