血糖波动与危重患者CRP TNF-α IL-6水平关系及预后的相关性研究  

Prognostic significance of mean amplitude of glucose excursions, CRP, TNF-α and IL-6 levels in critically ill patients

作　　者：李静思[1] 吕肖锋[1] 李广罡[2] 张星光[1] 陈彬[1] 焦秀敏[1] 刘巍[2] 宋斌[2] 

机构地区：[1]北京军区总医院内分泌科,100011 [2]北京军区总医院ICU重症医学科,100011

出　　处：《中国急救医学》2011年第3期206-209,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨血糖波动与危重患者血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平关系及和预后的相关性.方法 选择ICU危重患者60例.①按APACHEⅡ评分分为三组.采用动态血糖监测系统（CGMS）监测患者入院72 h内平均血糖波动幅度（MAGE）;测定空腹血清CRP、TNF-α和IL-6水平;观察28 d患者的预后情况.②回顾分析：根据危重患者入科第1个24 h测得MAGE值按由小到大排序,分四组,比较MAGE与APACHEⅡ评分和病死率的关系.结果 ①三组患者入科后MAGE与血清CRP、TNF-α、IL-6水平明显升高,与正常对照组比较差异有统计学意义（P＜0.01）,且MAGE与血清CRP、TNF-α及IL-6水平呈正相关（P＜0.01）.②经回顾分析提示,入科MAGE最高的第Ⅳ组患者,APACHEⅡ评分及病死率也最高（P＜0.01）,并且入科MAGE与APACHEⅡ评分呈正相关（P＜0.01）.结论 危重患者MAGE与血清炎症因子水平密切相关,且与患者危重程度一致,对判断预后具备一定意义.Objective To investigate the relationship between the mean amplitude of glucose excursions（ MAGE）, inflammatory factor CRP,TNF-α, IL- 6 and disease prognosis in critically ill patients in ICU. Methods 60 patients with serious diseases in ICU were enrolled. ① All these patients were divided into 3 groups according to APACHE Ⅱ score. We monitored MAGE by continuous glucose monitoring system （CGMS） for 72 h after admission, measured serum levels of CRP, TNF - α and IL - 6 on 1, 3 and 7 day respectively and observed clinical effect after 28 - day treatment. ②Retrospective analysis： the patients were divided into 4 groups according to MACE in the first 24 hours after admission, and the relationship among MAGE, APACHE Ⅱ score and mortality were discussed. Results ①Compared with normal controls, MAGE increased and correlated positively with CRP, TNF - α and IL- 6 （P 〈 0. 01 ） ; ②Retrospective analysis indicated that grouplV （the highest MAGE） had the grea- test APACHE Ⅱ score and mortality （P 〈0. 01 ）, and MAGE on admission correlated positively with APACHE Ⅱ score （ P 〈 0. 01 ）. Conclusion MAGE is closely associated with serum CRP, TNF - α and IL - 6, and is also in consistent with the severity of conditions in critically ill patients. Our study indicates MAGE is an instructive and meaningful tool for anticipating prognosis.

关 键 词：血糖波动 危重患者 炎症因子 肿瘤坏死因子-α(TNF-α) 白细胞介素-6(IL-6) C反应蛋白(CRP) 

分 类 号：R363.27[医药卫生—病理学]