随机血糖水平与高龄社区获得性肺炎患者住院临床结局关系的倾向值评分研究  

Propensity score study of the relationship between random blood glucose level and clinical outcomes of elderly patients with community-acquired pneumonia

作　　者：徐小敏 陆邦超[2] 王昕怡 张芳 舒磊 王晓霞 肖甜甜 陈祥菲 殷晶晶 李明泉 Xu Xiaomin Lu Bangchao Wang Xinyi Zhang Fang Shu Lei Wang Xiaoxia Xiao Tiantian Chen Xiangfei Yin Jingjing Li Mingquan(Department of Endocrinology, Nanfing General Hospital, Nanjing 210002, China)

机构地区：[1]解放军南京总医院内分泌科干部病区,210002 [2]南京大学医学院附属鼓楼医院老年医学科

出　　处：《中国综合临床》2017年第8期681-686,共6页Clinical Medicine of China

基　　金：江苏省干部保健科研课题（BJ15007）;南京市医学科技发展课题（YKK14074）;解放军南京总医院科研基金（2015066）

摘　　要：目的 探讨入院高血糖水平与高龄社区获得性肺炎患者临床预后的相关性.方法 基于病历记录系统（EMR）回顾性采集肺炎患者信息,完成必要的数据准备和整理.根据临床结局进行分组,比较组间人口学特征和临床指标,筛选潜在影响临床结局的变量;然后以随机血糖水平值8.6 mmol/L为切断点对患者进行分组,以临床结局为结局变量,随机血糖水平为分组变量,采用倾向值评分分析方法以比例为1：1最邻近匹配法生成配对样本评估血糖水平对病死率的影响;以住院时间为时间变量,采用生存分析方法,对研究对象进行COX比例模型分析.结果 最终共有568例患者纳入本次研究,其中住院期间出现死亡例数为197例（死亡组）;校正人口学特征、既往病史和血液检测指标后,发现白细胞、C反应蛋白、入院随机血糖与甘油三酯水平可能是患者死亡的相关因素（P〈0.05）;倾向值评分分析方法提示不同血糖水平组间患者病死率未表现有统计学差异;生存分析结果提示高血糖组患者病死率高于正常血糖组患者HR=1.68,95%CI（1.22,2.31）.结论 入院随机高血糖是高龄肺炎患者不良预后的重要指标,对于筛选和识别高危患者可能有一定意义.Objective To investigate the correlation between admission hyperglycemia and clinical prognosis in elderly patients with community-acquired pneumonia.Methods Based on the electrical medical record （EMR）,information of the patients with pneumonia was retrospectively collected and the necessary data were prepared and arranged.Based on clinical outcomes,demographic characteristics and clinical indicators were compared between groups in order to screen potential variables affecting clinical outcomes.Then,the random blood glucose level 8.6 mmol/L was considered to be the cutoff point for grouping patients,with clinical outcomes as outcome variables,random blood glucose levels as grouping variables,propensity score value analysis method was applied along with the ratio of 1：1 nearest neighbor matching method to generate paired samples in order to assess the impact of blood glucose level on mortality rate;With hospitalization time serving as time variable,survive analysis method was used to analyze COX proportional model.Results Five hundred and fifty-eight patients were enrolled in the analysis,197 patients of which were recorded dead during hospitalization （the dead group）.After the correction of demographic characteristics,past medical history and blood test indexes,white blood cells,C reactive protein,random blood glucose at admission and triglyceride levels were regarded as potential factors for the deaths of patients （P〈0.05）.However,the propensity score analysis method suggested that there was no significant difference between the blood glucose levels and mortality.The survival analysis showed that the mortality in the high blood glucose group was higher than that in the normal blood glucose group （HR=1.68,95%CI（1.22,2.31））.Conclusion Admission hyperglycemia is an important indicator of adverse prognosis in elderly patients with pneumonia.It may be of significance for screening and identifying high-risk patients.

关 键 词：高龄 肺炎 随机血糖 临床结局 

分 类 号：R563.1[医药卫生—呼吸系统]