血糖变异性指标预测急性胰腺炎持续性器官功能衰竭的价值研究

Study on the value of blood glucose variability indexes in predicting persistent organ failure after acute pancreatitis

目的探讨血糖变异性指标与急性胰腺炎(acute pancreatitis,AP)发生持续性器官功能衰竭(persistent organ failure,POF)的关系。方法前瞻性纳入2019年7月至2021年11月期间在四川大学华西医院中西医结合中心住院的AP伴高血糖患者,每日监测血糖≥4次,连续监测血糖至少3 d,分析血糖变异性指标对AP患者发生POF的预测价值。结果纳入559例AP患者,其中发生POF 95例。POF患者的入院时血糖值(11.0 mmol/L vs.9.6 mmol/L)、血糖最小值(6.8 mmol/L vs.5.8 mmol/L)和平均血糖浓度(9.6 mmol/L vs.8.7 mmol/L)高于未发生POF的患者,而血糖变异系数(16.6%vs.19.0%)低于未发生POF的患者(P<0.05)。校正混杂因素后,logistic回归分析结果显示,随入院时血糖值[OR=1.11,95%CI(1.04,1.19),P=0.002]、血糖最小值[OR=1.28,95%CI(1.10,1.48),P=0.001]、平均血糖浓度[OR=1.18,95%CI(1.04,1.33),P=0.010]增高,POF发生风险增加;随血糖变异系数增加,POF发生风险降低[OR=0.95,95%CI(0.92,0.99),P=0.021]。受试者工作特征曲线下面积(area under the curve,AUC)结果显示,入院时血糖值[AUC=0.787,95%CI(0.735,0.840)]预测POF的准确性最高,敏感性为60.0%,特异性为84.7%。结论高入院时血糖值、血糖最小值、平均血糖浓度,低血糖变异系数是入院时伴有高血糖AP患者发生POF的危险因素。

Objective To explore the relationship between blood glucose variability index and persistent organ failure(POF)in acute pancreatitis(AP).Methods We prospectively included those patients who were diagnosed with AP with hyperglycemia and were hospitalized in the West China Center of Excellence for Pancreatitis of West China Hospital of Sichuan University from July 2019 to November 2021.The patients were given blood glucose monitoring at least 4 times a day for at least 3 consecutive days.The predictive value of blood glucose variability index for POF in patients with AP was analyzed.Results A total of 559 patients with AP were included,including 95 cases of POF.Comparing with those without POF,patients with AP complicated by POF had higher levels of admission glucose(11.0 mmol/L vs.9.6 mmol/L),minimum blood glucose(6.8 mmol/L vs.5.8 mmol/L),mean blood glucose(9.6 mmol/L vs.8.7 mmol/L),and lower level of coefficient of variation of blood glucose(16.6%vs.19.0%),P<0.05.Logistic regression analyses after adjustment for confounding factors showed that the risk of POF increased with the increase of admission glucose[OR=1.11,95%CI(1.04,1.19),P=0.002],minimum blood glucose[OR=1.28,95%CI(1.10,1.48),P=0.001]and mean blood glucose[OR=1.18,95%CI(1.04,1.33),P=0.010];with the higher level of coefficient of variation of blood glucose[OR=0.95,95%CI(0.92,0.99),P=0.021],the risk of POF decreased.The results of area under the curve(AUC)of the receiver operator curves showed that AG[AUC=0.787,95%CI(0.735,0.840)]had the highest accuracy in predicting POF,with sensitivities of 60.0%and specificities of 84.7%.Conclusion High admission glucose,minimum blood glucose,mean blood glucose,and low coefficient of variation of blood glucose were risk factors for the development of POF in patients with hyperglycemic AP on admission.