PCT/HCO_(3)^(-)、CK、HBP与老年糖尿病酮症酸中毒伴感染患者预后的关系及联合预测预后效能分析  

Relationships between PCT/HCO_(3)^(-),CK and HBP with Prognoses of Elderly Patients with Diabetic Ketoacidosis Complicated by Infection and the Prognostic Efficacy of Combined Prediction

作　　者：韩慧萍 卢海龙 HAN Hui-ping;LU Hai-long(Department of Geriatrics,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院老年医学科,江苏徐州221000

出　　处：《解放军医药杂志》2021年第11期76-80,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：徐州市科技局课题(KC16SH078)。

摘　　要：目的探讨降钙素原与碳酸氢根比值(PCT/HCO_(3)^(-))、肌酸激酶(CK)、肝素结合蛋白(HBP)与老年糖尿病酮症酸中毒(DKA)伴感染患者预后的关系及联合预测预后的效能。方法选取2017年1月—2020年11月我院收治的174例DKA伴感染患者,根据1周内预后情况分为死亡组25例和生存组149例。比较2组治疗前及治疗1、2 d后PCT/HCO_(3)^(-)、CK、HBP、改良早期预警评分(MEWS),采用Pearson相关性分析探讨PCT/HCO_(3)^(-)、CK、HBP与MEWS评分的关系,采用Cox回归分析探讨预后影响因素,采用Kaplan-Meier生存曲线分析不同PCT/HCO_(3)^(-)、CK、HBP水平者生存率。结果死亡组治疗1、2 d后PCT/HCO_(3)^(-)、CK、HBP、MEWS评分高于生存组(P<0.05,P<0.01)。Pearson相关性分析显示,治疗1、2 d后PCT/HCO_(3)^(-)、CK、HBP与对应时间点MEWS评分呈正相关(P<0.01)。Cox回归分析显示,将治疗1、2 d后MEWS评分控制后,PCT/HCO_(3)^(-)、CK、HBP仍是预后影响因素(P<0.01)。受试者工作特征曲线分析显示,治疗2 d后各指标预测预后的曲线下面积(AUC)大于治疗1 d后,各指标联合预测预后的AUC大于相同时间点任一单一指标预测。Kaplan-Meier生存曲线分析显示,PCT/HCO_(3)^(-)、CK、HBP高危患者生存率低于低危患者(P<0.01)。结论PCT/HCO_(3)^(-)、CK、HBP与老年DKA伴感染患者病情程度及预后相关,联合检测对预后具有良好的预测效能。Objective To investigate relationships between procalcitonin to bicarbonate ratio(PCT/HCO_(3)^(-)),creatine kinase(CK)and heparin binding protein(HBP)with prognoses of elderly patients with diabetic ketoacidosis(DKA)complicated by infection and prognostic efficacy of the combined prediction.Methods A total of 174 patients with DKA complicated by infection admitted between January 2017 and November 2020 were divided into death group(n=25)and survival group(n=149)according to the prognosis conditions within one week.Levels of PCT/HCO_(3)^(-),CK,HBP and modified early warning score(MEWS)before and after treatment for 1 and 2 d were compared between two groups.Pearson correlation analysis was used to explore the relationships between PCT/HCO_(3)^(-),CK and HBP with MEWS score.Cox regression analysis was used to explore influencing factors of prognoses,and Kaplan-Meier survival curve was used to analyze survival rates of patients with different levels of PCT/HCO_(3)^(-),CK and HBP.Results Levels of PCT/HCO_(3)^(-),CK,HBP and MEWS in death group were significantly higher than those in survival group after treatment for 1 and 2 d(P<0.05,P<0.01).Pearson correlation analysis showed that PCT/HCO_(3)^(-),CK and HBP were positively correlated with MEWS scores at the corresponding time points after treatment for 1 and 2 d(P<0.01).Cox regression analysis showed that PCT/HCO_(3)^(-),CK and HBP were still influencing factors of prognoses after controlling the MEWS scores after treatment for 1 and 2 d(P<0.01).Receiver operating characteristic(ROC)curve analysis showed that the areas under the ROC curve(AUC)of each index to predict the prognoses after treatment for 2 d were greater than those after treatment for 1 d,and the AUC of combined prediction of the above indexes was greater than those predicted by any single index at the same time point.Kaplan-Meier survival curve analysis showed that the survival rate of patients with high-risk PCT/HCO_(3)^(-),CK and HBP was lower than that of low-risk patients(P<0.01).Conclusion PCT/HCO

关 键 词：糖尿病酮症酸中毒 感染 老年人 肌酸激酶 相关性 预后 

分 类 号：R587.2[医药卫生—内分泌]