血糖变异性参数在重症新型冠状病毒肺炎患者预后判断中的价值  

Role of blood glucose variability in the prognosis of severe corona virus disease 2019 patients

作　　者：胡森安 谭俊锋[2] 彭昌[2] 艾红红[2] 李丹 HU Senan;TAN Junfeng;PENG Chang;AI Honghong;LI Dan(Department of Clinical Laboratory,the People's Hospital of Gaoming District,Foshan 528500,Guangdong,China;Department of Respiratory Medicine,the People's Hospital of Gaoming District,Foshan 528500,Guangdong,China)

机构地区：[1]佛山市高明区人民医院检验科,广东佛山528500 [2]佛山市高明区人民医院呼吸内科,广东佛山528500

出　　处：《检验医学》2021年第4期400-403,共4页Laboratory Medicine

摘　　要：目的探讨血糖变异性参数在判断重型和危重型(统称为重症)新型冠状病毒肺炎(COVID-19)患者预后中的价值。方法收集83例重症COVID-19患者的一般资料、转入ICU时的急性生理与慢性健康评分Ⅱ(APACHEⅡ)、72 h内的动态血糖变异性参数[平均血糖波动幅度(Glu-MAGE)、血糖变异系数(Glu-CV)、血糖不稳定指数(Glu-GLI)及72 h平均血糖]。根据患者28 d内的预后情况分为生存组和死亡组。根据患者72 h监测的平均血糖,以11.1、7.8 mmol/L为临界值分为>11.1 mmol/L组、7.8~11.1 mmol/L组和<7.8 mmol/L组。根据72 h Glu-CV结果,按四分位法将所有患者分为4个组(Q_(1)组~Q_(4)组),再根据有无糖尿病史分为无糖尿病组和糖尿病组。比较各组的血糖变异性参数及死亡率。结果死亡组年龄、APACHEⅡ评分、72 h平均血糖、Glu-MAGE、Glu-GLI、Glu-CV显著高于生存组(P<0.05)。>11.1 mmol/L组Glu-MAGE、Glu-CV均高于7.8~11.1 mmol/L组和<7.8 mmol/L组(P<0.05),而7.8~11.1 mmol/L组与<7.8 mmol/L组之间差异均无统计学意义(P>0.05),其他项目3个组之间差异均无统计学意义(P>0.05);28 d病死率随血糖水平的升高而升高,3组间差异均有统计学意义(P<0.05)。在Q_(1)组~Q_(4)组中,糖尿病患者的28 d死亡率均高于无糖尿病患者(P<0.05)。无论是否有糖尿病,患者的28 d死亡率均随着Glu-CV的升高而升高(P<0.05)。结论重症COVID-19患者的死亡风险有随血糖变异增大而升高的趋势。Objective To investigate the role of blood glucose variability in the prognosis of patients with severe and critical(collectively referred to as severe)corona virus disease 2019(COVID-19)patients.Methods The general data of 83 patients with severe COVID-19 were collected,and acute physiological and chronic health evaluationⅡ(APACHEⅡ)score when transferred to intensive care unit(ICU),dynamic glucose variability data within 72 h[mean glucose fluctuation amplitude(Glu-MAGE),glucose-coefficient of variation(Glu-CV),glucose instability index(Glu-GLI)and 72 h mean glucose]were recorded.According to the prognosis of 28 d,the patients were classified into survival group and death group.According to the patients'average 72 h blood glucose,the cut-off values of 11.1 and 7.8 mmol/L,the patients were classified into>11.1 mmol/L,7.8-11.1 mmol/L and<7.8 mmol/L groups.Based on the results 72 h Glu-CV,the patients were classified into 4 groups by quartiles(Q_(1)-Q_(4)).According to the history of diabetes,the patients were classified into non-diabetic group and diabetic group.Blood glucose variability and mortality were compared in each group.Results The age,APACHEⅡscore,72 h mean glucose,Glu-MAGE,Glu-GLI,Glu-CV of death group were higher than those of survival group(P<0.05).In the>11.1 mmol/L group,Glu-MAGE,Glu-CV were higher than those in 7.8-11.1 mmol/L and<7.8 mmol/L groups(P<0.05).There was no statistical significance between 7.8-11.1 mmol/L group and<7.8 mmol/L group(P>0.05).The other items were not statistically significant among the 3 groups(P>0.05).The 28 d mortality increased with the increase of blood glucose,and the difference among the 3 groups had statistical significance(P<0.05).In Q_(1)-Q_(4) groups,the 28 d mortality rate of 28 d of diabetic patients was higher than that of nondiabetic patients(P<0.05).With or without diabetes,the 28 d mortality rate increased with the increase of Glu-CV(P<0.05).Conclusions Death risk in patients with severe COVID-19 increases with the increasing of blood glucose variabili

关 键 词：血糖变异性参数 新型冠状病毒肺炎 预后 

分 类 号：R446.1[医药卫生—诊断学]