糖化血清蛋白联合血糖变异度对老年脓毒症患者继发持续性炎症-免疫抑制-分解代谢综合征的预测价值  

Predictive value of glycosylated serum protein combined with glycemic variability on secondary persistent inflammatory immunosuppressed catabolic syndrome prediction in elderly septic patients

作　　者：肖飞[1,2] 王银[2] 林海焕[3] 莫泽珣 陈蕊[2] 谢栋[4] Xiao Fei;Wang Yin;Lin Haihuan;Mo Zexun;Chen Rui;Xie Dong(Department of Medical Intensive Care Unit,Taihe Branch of Nanfang Hospital,Southern Medical University,Guangzhou 510540,Guangdong,China;Department of Geriatric Intensive Care Unit,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou 510010,Guangdong,China;Department of Intensive Care Unit,Guangzhou First People's Hospital,Guangzhou 510180,Guangdong,China;Department of Health Management,the 421st Hospital of the PLA,Guangzhou 510318,Guangdong,China)

机构地区：[1]南方医科大学南方医院太和分院内科重症监护室,广东广州510540 [2]广州军区广州总医院老年重症医学科,广东广州510010 [3]广州市第一人民医院ICU,广东广州510180 [4]解放军第四二一医院健康管理科,广东广州510318

出　　处：《中华危重病急救医学》2018年第11期1051-1055,共5页Chinese Critical Care Medicine

基　　金：广东省医学科学技术研究项目(A2017230);广东省科技计划项目(2012A061400010);广东省广州市科研条件建设项目(2012-224-5).

摘　　要：目的探讨糖化血清蛋白(GSP)联合血糖变异度(GV)对老年脓毒症患者继发持续性炎症-免疫抑制-分解代谢综合征(PICS)的预测价值。方法采用回顾性研究方法,选择2014年1月至2017年12月在广州军区广州总医院老年重症医学科(ICU)工作期间收治的年龄≥60岁且入ICU 28d存活的脓毒症患者。按照PICS诊断标准,根据患者入ICU 14d内是否发生PICS分为两组。收集患者一般资料,包括性别、年龄、基础疾病、感染部位、ICU住院时间,记录24h内急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)以及入院1d GSP和1d、14d淋巴细胞计数(LYM)、C-反应蛋白(CRP)、白蛋白(ALB)、前白蛋白(PA)水平;记录患者入ICU第1天和第14天血糖水平,计算GV。采用随机森林法对数据进行交叉验证;绘制受试者工作特征曲线(ROC),评价血糖代谢指标对PICS的预测价值。结果共入选315例老年脓毒症患者,排除28d内死亡、恶性肿瘤、严重的自身免疫性疾病、正在接受免疫抑制治疗患者,最终共132例患者纳入分析,其中PICS组45例,非PICS组87例。PICS组患者ICU住院时间较非PICS组明显延长[d:35.0(22.0,49.5)比8.0(5.0,23.0),P<0.01];但两组患者性别、年龄、基础疾病、感染部位、APACHEⅡ评分等基线资料比较差异无统计学意义。①PICS诊断指标:随入ICU时间延长,LYM和PA在非PICS组升高、而在PICS组降低,两组CRP和ALB均呈降低趋势;PICS组入ICU 14d的LYM、ALB和PA水平均显著低于非PICS组[LYM(×10^9/L):0.6(0.5,0.7)比1.1(0.9,1.6),ALB(g/L):25.4±2.7比29.9±4.3,PA(g/L):0.08(0.05,0.14)比0.11(0.10,0.21),均P<0.01],而CRP水平则显著高于非PICS组(mg/L:87.5±56.3比49.2±49.1,P<0.01)。②血糖代谢指标:PICS组入ICU 1d的GSP水平显著低于非PICS组(mmol/L:2.3±0.6比2.7±0.6,P<0.01);1d和14d血糖水平、GV与非PICS组比较差异均无统计学意义[血糖(mmol/L):1d为10.0±3.3比9.4±3.3,14d为10.8±3.6比10.4±3.5;GV:1d为(24.2±1.4)%比(23.7±1.2)%,14d为(24Objective To investigate the predictive value of glycosylated serum protein (GSP)combined with glycemic variability (GV)in persistent inflammation immunosuppressive catabolic syndrome (PICS)in elderly septic patients.Methods A retrospective study was conducted.The septic patients aged ≥60 years old with 28 days hospitalized duration admitted to geriatric intensive care unit (ICU)of Guangzhou General Hospital of Guangzhou Military Command from January 2014 to December 2017 were enrolled.The patients were divided into two groups according to whether PICS occurred within 14 days after ICU admission according to the PICS diagnostic criteria. General patients'data including gender,age,underlying disease,site of infection,the length of ICU stay were collected, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ),GSP at 1 day after hospitalization and lymphocyte count (LYM),C-reactive protein (CRP),albumin (ALB),prealbumin (PA)levels at 1 day and 14 days were recorded.The levels of blood glucose on the 1st day and 14th day were observed,the GV was calculated.Data were cross-validated using the random forest method.Receiver operating characteristic (ROC)curve was plotted to evaluate the predictive value of glycemic parameters for PICS.Results A total of 315 elderly septic patients were included.Patients with malignant tumors,severe autoimmune diseases,and immunosuppressive therapy or dead within 28days of hospitalization were excluded.A total of 132 patients were enrolled in the analysis,including 45 in the PICS group and 87 in the non-PICS group.The length of ICU stay in the PICS group was significantly longer than that in the non-PICS group [days: 35.0(22.0,49.5)vs.8.0(5.0,23.0),P <0.01].No significant difference in the baseline data of gender,age,underlying disease,infection site or APACHE Ⅱ score between the two groups was found.(1)Parameters for PICS diagnosis:with the prolongation of ICU stay,LYM and PA in the non-PICS group were increased and those in the PICS group were decreased,and CRP and ALB l

关 键 词：糖化血清蛋白 血糖变异度 老年 脓毒症 持续性炎症-免疫抑制-分解代谢综合征 

分 类 号：R459.7[医药卫生—急诊医学]