糖化血红蛋白对糖尿病合并脓毒症预后的评估  

Relationship of glycated hemoglobin with prognosis in diabetes with sepsis

作　　者：郝艳[1] 陆士奇[1] 金钧[1] 黄坚[1] 王俊[1] 黄芳[1] HAO Yan;LU Shiqi;JIN Jun;HUANG Jian;WANG Jun;HUANG Fang(Department of Intensive Care Unit,the First Aftiliated Hospital of Sooch-ow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院重症医学科,江苏苏州215000

出　　处：《实用医学杂志》2021年第6期730-734,共5页The Journal of Practical Medicine

摘　　要：目的探讨糖尿病患者并发脓毒症时,糖化血红蛋白(HbA1c)水平对预后的预测价值。方法回顾分析2018年5月至2019年6月苏州大学附属第一医院重症医学科收治的糖尿病并发脓毒症102例患者,将其分为HbA1c升高组(HbA1c≥6.5%)和HbA1c正常组(HbA1c <6.5%),分析两组临床资料。生存分析采用Kaplan-Meier法和log-rank检验。采用Logistic回归分析和Cox回归分析来研究患者器官功能障碍进展和ICU病死率的影响因素。结果 102例患者中,HbA1c升高组39例,HbA1c正常组63例。升高组器官功能障碍进展发生率(48.7%)较正常组(22.2%)明显升高(P=0.001),升高组ICU病死率(38.5%)较正常组(7.9%)升高(P <0.001)。二元Logistic回归分析表明HbA1c≥6.5%(OR=1.070,95%CI:1.006~1.138,P=0.031),血乳酸(OR=1.557,95%CI:1.166~2.081,P=0.003)是器官功能障碍进展的独立危险因素。Kaplan-Meier分析和Log-Rank检验显示,HbA1c≥6.5%的患者生存期明显缩短(P <0.001)。Cox多因素生存分析显示HbA1c≥6.5%(HR=1.394,95%CI:1.157~1.678,P <0.001)、血乳酸(HR=1.555,95%CI:1.165~2.077,P=0.003)以及年龄(HR=1.080,95%CI:1.004~1.162,P=0.039)是ICU死亡的独立危险因素。结论糖尿病脓毒症患者HbA1c水平对预后评估有一定的临床价值。Objective To explore the relationship of glycated hemoglobin with organ dysfunction progression and ICU mortality in diabetes with sepsis.Methods 102 diabetes with sepsis admitted in the department of Intensive Care Unit of the First Aftiliated Hospital of Soochow University from May 2018 to June 2019 were divided into the two group according to the level of glycated hemoglobin:the abnormal glycated hemoglobin group(HbA1c≥6.5%) and the normal glycated hemoglobin group(HbA1c <6.5%).Survival analysis was performed by kaplan-Meier method and log-rank test.Logistic regression analysis and Cox regression analysis were used to study the influencing factors of the progression of organ dysfunction and ICU mortality.Results Among the 102 patients,39 were in the group with abnormal glycated hemoglobin and 63 were in the group with normal glycated hemoglobin.The incidence of organ dysfunction progression in the abnormal group was significantly higher than that in the normal group(48.7% vs.22.2%,P=0.001).The ICU mortality in the abnormal group was significantly higher than that in the normal group(38.5% vs.7.9%,P <0.001).Multivariate Logistic regression analysis showed that HbA1c) 6.5%(OR=1.070,95% CI:1.006 ~1.138,P=0.031)and lactic acid level(OR=1.557,95%CI:1.166-2.081,P=0.003) were independent risk factors for the progression of organ dysfunction.Kaplan-Meier analysis along with the log-rank test showed that the survival period was significantly shorter in patients with an HbA1c level ≥6.5% than in those with an HbA1c level <6.5%(P <0.001).Multivariable Cox proportional hazard analysis with backward elimination indicated that HbA1c ≥ 6.5%(HR=1.394,95% CI:1.157 ~1.678,P <0.001),high lactic acid level(HR=1.555,95%CI:1.165~2.077,P=0.003) and age(HR=1.080,95%CI:1.004 ~1.162,P=0.039)were significant,independent predictors of ICU mortality.Conclusions In diabetes with sepsis,higher glycated hemoglobin at ICU admission is associated with progression of organ dysfunction and ICU mortality.

关 键 词：糖尿病 HBA1C 脓毒症 器官功能障碍 预后 

分 类 号：R587.1[医药卫生—内分泌]