糖尿病合并肺部感染的危险因素、HbAlc、PCT水平变化及对患者预后转归的预测价值  

A Study of Risk Factors of Diabetes Mellitus with Pulmonary Infection,Changes of Levels of HbAlc and PCT and Predictive Value on Prognostic Outcomes of Patients

作　　者：吉黎 廖继成[1] 陈青云 王雪梅[1] 郭宗琳 JI Li;LIAO Jicheng;CHEN Qingyun;WANG Xuemei;GUO Zonglin(Department of Laboratory Medicine,Chengdu Sixth People’s Hospital,Chengdu 610081,China;Department of Nephrology,Chengdu Sixth People’s Hospital,Chengdu 610081,China)

机构地区：[1]成都市第六人民医院,检验科,四川成都610081 [2]成都市第六人民医院,肾病科,四川成都610081

出　　处：《标记免疫分析与临床》2023年第3期476-480,516,共6页Labeled Immunoassays and Clinical Medicine

基　　金：成都市卫生健康委员会科研课题(编号:2022520)。

摘　　要：目的分析糖尿病合并肺部感染的危险因素,并评估糖化血红蛋白(glycated hemoglobin,HbAlc)、降钙素原(procalcitonin,PCT)水平对患者预后转归的预测价值。方法回顾性分析2019年2月至2021年12月我院102例2型糖尿病(type 2 diabetes mellitus,T2DM)合并肺部感染患者(感染组)及94例未合并肺部感染T2DM患者(未感染组)临床资料,分析感染组病原菌分布情况,采用Logistic模型评估T2DM合并肺部感染的危险因素;并记录感染组治疗前后外周血HbAlc、PCT水平变化情况,根据治疗转归情况分为临床有效组及无效组,比较其治疗前外周血HbAlc、PCT水平差异,利用受试者工作特征曲线(ROC)分析治疗前外周血HbAlc、PCT及其联合检测对T2DM合并肺部感染患者预后转归的预测价值。结果102例T2DM合并肺部感染患者共检出69株病原菌,其中革兰阴性菌最多(65.22%),革兰阳性菌其次(33.33%),真菌最少(1.45%)。感染组及未感染组性别、甲状腺功能减退情况比较,差异无统计学意义(P>0.05);感染组年龄、T2DM病程、住院时间及高血压、冠心病、低蛋白血症、脑梗死发生率均高于未感染组(P<0.05),且年龄≥60岁、T2DM病程≥10年、高血压、冠心病、低蛋白血症、脑梗死均为影响T2DM合并肺部感染的危险因素(OR=2.487、1.654、1.411、1.458、1.353、1.322,P<0.05)。感染组治疗前外周血HbAlc、PCT水平明显高于治疗后水平(P<0.05)。102例感染组患者77例治愈,14例好转,共91例纳入临床有效组;11例无效,纳入无效组;临床有效组治疗前外周血HbAlc、PCT水平均低于无效组(P<0.05);且治疗前外周血HbAlc、PCT对T2DM合并肺部感染患者转归不良均有较高预测价值(AUC=0.864、0.896,P<0.05),其cut-off值为9.565%、2.270ng/mL,且两项联合检测预测价值最高(AUC=0.930,P<0.05)。结论对于年龄较高、病程较长及合并高血压、冠心病、低蛋白血症、脑梗死的T2DM患者,应警惕肺部感染,本院T2DM合并�Objective To analyze the risk factors of diabetes mellitus with pulmonary infection and evaluate the predictive value of glycated hemoglobin(HbAlc)and procalcitonin(PCT)on prognostic outcomes of patients.Methods The clinical data of 102 patients with type 2 diabetes mellitus(T2DM)complicated with pulmonary infection(infected group)and 94 T2DM patients without pulmonary infection(uninfected group)from February,2019 to December,2021 in our hospital were retrospectively analyzed.The distribution of pathogenic bacteria was analyzed in the infected group,and logistic model was used to evaluate the risk factors of T2DM with pulmonary infection.The levels of peripheral blood HBALC and PCT were recorded in the infected group before and after treatment,and the patients were divided into the clinically effective group and ineffective group according to the treatment outcomes.The levels of peripheral blood HbAlc and PCT were compared before treatment,and the receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of peripheral blood HbAlc and PCT before treatment and their combination on the prognostic outcomes of T2DM patients with pulmonary infection.Results A total of 69 pathogenic bacteria were detected among 102 patients with T2DM complicated with pulmonary infection,among which Gram-negative bacteria were the most(65.22%),Gram-positive bacteria were the second(33.33%)and fungi were the least(1.45%).There were no significant differences in gender and hypothyroidism between the infected group and uninfected group(P>0.05).Age,T2DM duration,hospital stay and incidence rates of hypertension,coronary heart disease,hypoproteinemia and cerebral infarction in the infected group were all higher than those in the uninfected group(P<0.05),and age≥60 years old,T2DM duration≥10 years,hypertension,coronary heart disease,hypoproteinemia and cerebral infarction were independent risk factors affecting T2DM with pulmonary infection(OR=2.487,1.654,1.411,1.458,1.353,1.322,P<0.05).The levels of peripheral

关 键 词：2型糖尿病 肺部感染 病原菌 危险因素 糖化血红蛋白 降钙素原 

分 类 号：R587.1[医药卫生—内分泌]