重症颅脑损伤病人血糖波动对炎症指标和继发性肺炎的影响  

Effects of blood glucose fluctuation on inflammatory level and secondary pneumonia in patients with severe craniocerebral injury

作　　者：陈万[1] 陈春霞[2] 蓝胜勇[3] 吕立文[1] 唐宇涛[1] 朱良峰[1] CHEN Wan;CHEN Chunxia;LAN Shengyong;LYU Liwen;TANG Yutao;ZHU Liangfeng(Department of Emergency,People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi Zhuang Auton-omous Region 530021,China;Department of Hyperbaric oxygen,People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi Zhuang Autonomous Region 530021,China;Department of Neurosurgery,People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi Zhuang Auton-omous Region 530021,China)

机构地区：[1]广西壮族自治区人民医院急诊科,广西壮族自治区南宁530021 [2]广西壮族自治区人民医院高压氧科,广西壮族自治区南宁530021 [3]广西壮族自治区人民医院神经外科,广西壮族自治区南宁530021

出　　处：《安徽医药》2020年第10期1975-1978,共4页Anhui Medical and Pharmaceutical Journal

基　　金：广西科技计划项目(桂科AB17292091);广西卫计委自筹经费科研课题(Z2016618,Z2016582)。

摘　　要：目的探讨重症颅脑损伤病人血糖波动对体内炎症指标及继发性肺炎的影响及意义。方法选择2015年10月至2017年12月广西壮族自治区人民医院首次诊断发病≤24 h的重症颅脑损伤病人47例,采用动态血糖监测系统(CGMs)对病人进行72 h的血糖监测,记录血糖波动指标包括初始血糖值(GluAdm)、血糖平均值(GluMean)、最低血糖值(GluMin)、最高血糖值(GluMax)、血糖标准差(GluSD)、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)和血糖不稳定指数(GLI);同时检测血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)及降钙素原(PCT)水平,并采用高分辨率胸部CT明确病人肺炎情况,根据是否存在肺部感染分为感染组和非感染组。采用Spearman法分析血糖波动指标与病人临床资料的相关性,采用logistic回归法分析病人出现肺炎的影响因素。结果感染组与非感染组入院时性别、年龄、全身性感染相关性器官功能衰竭评分(SOFA)评分、激素使用例数比较均差异无统计学意义(均P>0.05)。非感染组病人GluMean、GluSD、LAGE、GLI、MAGE水平明显低于感染组[(9.69±0.86)比(10.54±0.86)mmol/L,(1.92±0.77)比(2.52±0.55)mmol/L,(8.10±1.60)比(11.12±1.83)mmol/L,(33.34±9.20)比(54.28±6.25)mmol/L,(3.66±0.75)比(5.16±0.95)mmol/L],血清RP、IL-6、PCT水平明显高于非感染组[(15.17±0.96)比(17.82±0.96)mg/L,(25.81±1.53)比(27.62±1.80)ng/L,(0.69±0.10)比(2.17±0.11)ng/mL,均P<0.05]。logistic回归分析结果显示LAGE、MAGE是预测出现肺炎的危险因素(P<0.05)。结论血糖波动是重度颅脑损伤后全身炎性因子释放重要影响因素,LAGE、MAGE与继发性肺炎密切相关。Objective To investigate the effects of blood glucose fluctuation on inflammatory level and secondary pneumonia in patients with severe craniocerebral injury.MethodsFrom October 2015 to December 2017,a total of 47 patients with severe craniocerebral injury in People’s Hospital of Guangxi Zhuang Autonomous Region were enrolled in the observation group.Blood glucose of patients was monitored by a dynamic glucose monitoring system(CGMs)for 72 h,and the blood sugar fluctuation index,including average blood sugar(GluMean),low blood sugar value(GluMin),high blood sugar levels(GluMax),blood glucose standard deviation(GluSD),maximum blood glucose fluctuation range(LAGE),average blood glucose fluctuation range(MAGE)and blood glucose instability index(GLI),were recorded;Serum interleukin-6(Il-6),c-reactive protein(CRP)and procalcitonin(PCT)were also detected,and the pulmonary inflammation was examined by high-resolution CT,and the patients were divided into infection group and non-infection group according to the presence or absence of pulmonary infection.Spearman method was used to analyze the correlation between blood glucose fluctuation index and patients’clinical data,and Logistic regression method was used to analyze the influencing factors of pneumonia in patients.ResultsThere were no significant differences between infected group and non-infected group in the parameters of sex,age,SOFA scoring,and cases of application of hormone.The indicators of GluMean,GluSD,LAGE,GLIand MAGE in the non-infected group were significantly lower than those in the non-infected group[(9.69±0.86)vs.(10.54±0.86)mmol/L,(1.92±0.77)vs.(2.52±0.55)mmol/L,(8.10±1.60)vs.(11.12±1.83)mmol/L,(33.34±9.20)vs.(54.28±6.25)mmol/L,(3.66±0.75)vs.(5.16±0.95)mmol/L],and the inflammatory factors including CRP,IL-6 and PCT were also significantly higher than those in the non-infected group[(15.17±0.96)vs.(17.82±0.96)mg/L,(25.81±1.53)vs.(27.62±1.80)ng/L,(0.69±0.10)vs.(2.17±0.11)ng/mL,all P<0.05].Logistic regression analysis showed that LAGE

关 键 词：颅脑损伤 白细胞介素类 C反应蛋白质 降钙素基因相关肽 血糖波动 继发性肺炎 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]