胰岛素分泌指数在急性呼吸窘迫综合征患者病情评估和多脏器衰竭及预后预测中的应用  

Application of insulin secretion index in disease assessment,multiple organ failure and prognosis prediction in patients with acute respiratory distress syndrome

作　　者：吴杭捷 张锦丽 Wu Hangjie;Zhang Jinli(Department of Critical Care Medicine,Hangzhou Hospital of Zhejiang Medical Health Group,Hangzhou 310022,China)

机构地区：[1]浙江省医疗健康集团杭州医院重症医学科,杭州310022

出　　处：《中国医师进修杂志》2022年第11期968-973,共6页Chinese Journal of Postgraduates of Medicine

基　　金：杭州市医药卫生科技项目(OO20190638)。

摘　　要：目的探讨胰岛素分泌指数(HOMA-β)在急性呼吸窘迫综合征(ARDS)患者病情评估和多脏器衰竭(MOF)及预后预测中的应用效果。方法回顾性分析2019年1月至2021年2月浙江省医疗健康集团杭州医院住院治疗的ARDS患者96例的临床资料,根据其MOF发生情况,分为MOF组(38例)和非MOF组(58例)。收集比较两组基线HOMA-β、氧合指数、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)及28 d病死率等。比较不同生存预后ARDS患者的HOMA-β、氧合指数、APACHEⅡ、SOFA。Logistic回归模型分析HOMA-β、氧合指数、APACHEⅡ、SOFA对ARDS患者MOF和生存预后的影响。Pearson线性相关法分析ARDS患者HOMA-β与氧合指数、APACHEⅡ、SOFA的关系。绘制受试者工作特征(ROC)曲线分析HOMA-β对ARDS患者MOF和预后预测效能。结果96例ARDS患者MOF发生率和28 d病死率分别为39.58%(38/96)和31.25%(31/96)。与非MOF组比较,MOF组患者HOMA-β、氧合指数均较低[126.37±28.75比178.52±32.66、(125.41±18.77)mmHg(1 mmHg=0.133 kPa)比(153.62±26.42)mmHg],而APACHEⅡ、SOFA和28 d病死率则较高[(23.61±4.68)分比(10.96±2.85)分、(11.24±1.65)分比(5.62±0.87)分、65.79%(25/38)比10.34%(6/58)],差异有统计学意义(P<0.05)。与存活ARDS患者比较,死亡ARDS患者的HOMA-β、氧合指数均较低[89.62±21.17比195.43±35.64、(121.66±21.06)mmHg比(158.87±28.71)mmHg],APACHEⅡ、SOFA均较高[(25.78±5.42)分比(8.84±2.51)分、(12.38±1.22)分比(4.88±0.83)分],差异有统计学意义(P<0.05)。Logistic回归模型分析结果显示,ARDS患者HOMA-β、氧合指数、APACHEⅡ、SOFA均为其MOF和生存预后的影响因素(P<0.05)。Pearson线性相关分析结果显示,ARDS患者HOMA-β与其氧合指数呈正相关(P<0.05),与其APACHEⅡ、SOFA则呈负相关(P<0.05)。ROC曲线分析结果显示,ARDS患者HOMA-β对其MOF和预后均具有较高的预测效能。结论HOMA-β在ARDS患者中的水平较低,与其病情、MOF发生情况Objective To investigate the effect of insulin secretion index(HOMA-β)in the evaluation of the condition of patients with acute respiratory distress syndrome(ARDS),multiple organ failure(MOF)and prognosis prediction.Methods A retrospective analysis of the clinical data of 96 patients with ARDS hospitalized in Hangzhou Hospital of Zhejiang Medical Health Group from January 2019 to February 2021 was divided into MOF group(38 cases)and non-MOF group(58 cases).The baseline HOMA-β,oxygenation index,acute physiology and chronic health scoreⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and 28 d case fatality rate were collected and compared between the two groups.Compare the HOMA-β,oxygenation index,APACHEⅡscore,SOFA of ARDS patients with different survival prognosis.Logistic regression model analyzed the influence of HOMA-β,oxygenation index,APACHEⅡ,SOFA on the MOF and survival prognosis of ARDS patients.Pearson linear correlation method was used to analyze the relationship between HOMA-βand oxygenation index,APACHEⅡ,SOFA in ARDS patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive power of HOMA-βon MOF and prognosis of ARDS patients.Results The incidence of MOF and 28 d case fatality rate in 96 patients with ARDS were 39.58%(38/96)and 31.25%(31/96),respectively.The HOMA-βand oxygenation index in the MOF group were significantly lower than those in non-MOF group:126.37±28.75 vs.178.52±32.66,(125.41±18.77)mmHg(1 mmHg=0.133 kPa)vs.(153.62±26.42)mmHg,while the APACHEⅡ,SOFA and 28 d case fatality rate were significantly higher than those in non-MOF group:(23.61±4.68)points vs.(10.96±2.85)points,(11.24±1.65)points vs.(5.62±0.87)points and 65.79%(25/38)vs.10.34%(6/58),and there were statistical differences(P<0.05).The HOMA-βand oxygenation index in dead ARDS patients were significantly lower than those in surviving ARDS patients:89.62±21.17 vs.195.43±35.64 and(121.66±21.06)mmHg vs.(158.87±28.71)mmHg,the APACHEⅡand SOFA were significantly higher than t

关 键 词：呼吸窘迫综合征 成人 胰岛素分泌指数 氧合指数 多脏器衰竭 病死率 

分 类 号：R563.8[医药卫生—呼吸系统]