脓毒血症合并应激性高血糖患者低血糖事件与死亡风险增加的相关性及机制研究  

The Correlation and Mechanism of Hypoglycemic Event and Increased Mortality in Septic Patients with Stress Hyperglycemia

作　　者：曾凡[1] 钟吉文[1] 赵灵[1] 

机构地区：[1]广东省珠海市人民医院重症医学科,519000

出　　处：《岭南急诊医学杂志》2016年第5期433-435,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨低血糖事件与脓毒血症合并应激性高血糖患者死亡率增加之间的相关性及相应机制。方法:纳入我院ICU住院的脓毒血症合并应激性高血糖患者为研究对象,予强化胰岛素治疗并监测血糖,按患者的血糖浓度分成3组:正常血糖组(高于3.9 mmol/L),轻度低血糖组(2.3-3.9 mmol/L)和重度低血糖组(低于2.3 mmol/L);分别测定各组活性氧自由基(ROS)水平、丙二醛(MDA)水平、超氧化物歧化酶(SOD)活性、谷胱甘肽(GSH)水平,并观察各组患者的30天死亡率。结果:三组的30天死亡率、ROS水平及MDA水平均为正常血糖组<轻度低血糖组<重度低血糖组,但轻度低血糖组与重度低血糖组间MDA水平差别无统计学意义(P>0.05);三组的SOD活性及GSH水平均为为正常血糖组>低度低血糖组>重度低血糖组,差别有统计学意义(P<0.05)。结论 :脓毒血症合并应激性高血糖患者发生低血糖事件时患者死亡率增加,并且与低血糖的程度相关;这种现象的产生可能与氧化应激损伤机制相关。Objective ：To investigate the correlation and mechanism of hypoglycemic event and increased mortality in septic patients with stress hyperglycemia. Methods ：Septic patients with stress hyperglycemia admitted to intensive care unit. Each patient was treated with enhanced insulin-therapy. According to their blood glucose level,patients were divided into 3 different groups ： normal blood glucose group（3.9 mmol / L）, mild hypoglycemic group（2.3-3.9 mmol / L） and severe hypoglycemic group（2.3 mmol / L）. Reactive oxygen species（ROS）, malonic dialdehyde（MDA）, superoxide dismutase（SOD） and glutathione（GSH） were all detected in each group of patients.30-day mortality had been observed. Results ： The differences regarding age, sex, odds of smoking, odds of alcohol intake as well as body mass index（BMI） are not significant（P〈0.05） among patients in the three groups. 30-day mortality, ROS level and MDA level in the three groups were as follow ： normal blood glucose group mild hypoglycemia group severe hypoglycemia group. It is noteworthy that there is no significant difference in MDA among patients in mild hypoglycemia and severe hypoglycemia group. SOD activity and GSH level in the three groups are significantly different as follow ： normal blood glucose group mild hypoglycemia group severe hypoglycemia group. Conclusion ： The occurrence of hypoglycemic event could increase mortality in septic patients with stress hyperglycemia, which is parallel to the level of hypoglycemia. The phenomenon is related to mechanisms concerning oxidative stress injury.

关 键 词：低血糖 脓毒血症 氧化应激 死亡率 

分 类 号：R459.7[医药卫生—急诊医学]