GV联合APACHEⅡ对糖尿病合并脓毒症休克患者预后的预测价值  

Prognostic value of GV combined with APACHE Ⅱ in diabetic patients with septicshock

作　　者：姚佳丽 金聪 陈琨[1] 彭伟[1] 刘瑞鑫 YAO Jiali;JIN Cong;CHEN Kun;PENG Wei;LIU Ruixin(Department of Critical Care Medicine,Jinhua Central Hospital,Jinhua 321000,Zhejiang,China;Department of Breast and Thyroid Surgery,Jinhua Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华市中心医院重症医学科,浙江金华321000 [2]金华市中心医院乳甲外科,浙江金华321000

出　　处：《中国现代医生》2023年第30期42-46,共5页China Modern Doctor

摘　　要：目的探讨血糖变异度(glycemic variability,GV)联合急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)对糖尿病(diabetes mellitus,DM)合并脓毒症休克患者预后的预测价值。方法选取2020年3月至2022年1月于金华市中心医院重症监护病房(intensive care unit,ICU)住院治疗的102例脓毒症休克患者,按是否合并DM分为两组:DM伴脓毒症休克组(48例)和非DM伴脓毒症休克组(54例)。收集患者的一般资料,记录患者确诊脓毒症休克后第1~14天每日血糖水平,计算GV。采用二元Logistic回归分析影响脓毒症休克患者预后的因素,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),评估GV联合APACHEⅡ对DM伴脓毒症休克患者预后的预测价值。结果与非DM伴脓毒症休克组相比,DM伴脓毒症休克组患者的ICU住院天数、APACHEⅡ、糖化血红蛋白(glycosylated hemoglobin,HbA1c)和GV水平显著升高,淋巴细胞计数(lymphocyte,LYM)水平降低(P<0.05);GV与APACHEⅡ呈正相关(r=0.856,P<0.05);二元Logistic回归分析示GV和APACHEⅡ可能是影响脓毒症休克患者预后的独立危险因素(P<0.05);ROC曲线结果显示GV和APACHEⅡ对DM伴脓毒症休克患者均有一定的预测价值,以GV联合APACHEⅡ曲线下面积(area under the curve,AUC)最大为0.860(P<0.05),敏感度为95.6%,特异性为68.9%。结论GV联合APACHEⅡ对DM伴脓毒症休克患者的预后有预测价值。Objective To investigate the correlation between glycemic variability(GV)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)prognostic value in diabetic patients with septic shock.Methods A total of 102 patients with septic shock hospitalized in the intensive care unit(ICU)of Jinhua Central Hospital from March 2020 to January 2022 were selected and divided into two groups according to whether they were complicated with diabetes mellitus(DM):DM with septic shock group(48 cases)and non-DM with septic shock group(54 cases).General data of the patients were collected,daily blood glucose from 1 day to 14 days after the diagnosis of septic shock were recorded,and to calculate GV.Binary Logistic regression was used to analyze the factors affecting the prognosis of patients with septic shock,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of GV combined with APACHEⅡin diabetic patients with septic shock.Results In DM with septic shock group the days of ICU stay,APACHEⅡ,glycosylated hemoglobin(HbA1c)and GV levels were significantly higher,while lymphocyte(LYM)levels were lower than those in the non-DM with septic shock group(P<0.05);GV was positively correlated with APACHEⅡ(r=0.856,P<0.05);Binary Logistic regression analysis showed that GV and APACHEⅡmay be independent risk factors for the prognosis of patients with septic shock(P<0.05);ROC curve results showed that both GV and APACHEⅡhad certain predictive value in diabetic patients with septic shock.The maximum area under the curve(AUC)of GV combined with APACHEⅡwas 0.860(P<0.05)the sensitivity was 95.6%,and the specificity was 68.9%.Conclusion GV combined with APACHEⅡhas predictive value in the prognosis of diabetic patients with septic shock.

关 键 词：血糖变异度 急性生理学与慢性健康状况评分Ⅱ 脓毒症休克 糖尿病 

分 类 号：R589[医药卫生—内分泌]