急性多发伤后早期血糖波动对创伤后应激障碍发病的影响  

Influence of early blood glucose fluctuations after acute multiple injuries on post-traumatic stress disorder

作　　者：王京京 蒋文佳 李彦泽 薛婷 叶英 燕宪亮 许铁 花嵘 Wang Jingjing;Jiang Wenjia;Li Yanze;Xue Ting;Ye Ying;Yan Xianliang;Xu Tie;Hua Rong(Department of Emergency Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Graduate School/Department of Emergency and Rescue Medicine,Xuzhou Medical University,Xuzhou 221002,China;Jiangsu Provincial Institute of Health Emergency Response,Xuzhou 221002,China;Department of Emergency,Jiangning Hospital,Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]徐州医科大学附属医院急诊医学科,徐州221002 [2]徐州医科大学研究生院/急救与救援医学系,徐州221002 [3]江苏省卫生应急研究所,徐州221002 [4]南京医科大学附属江宁医院急诊科,南京211100

出　　处：《中华急诊医学杂志》2024年第5期623-629,共7页Chinese Journal of Emergency Medicine

基　　金：江苏省麻醉学重点实验室开放项目(XZSYSKF2021007);江苏省研究生科研与实践创新计划项目(SJCX22_1269)。

摘　　要：目的探讨急性多发伤后早期血糖波动对创伤后应激障碍(post-traumatic stress disorder,PTSD)发病的影响。方法本研究为病例对照研究,选取2022年3月至2023年3月因急性多发伤入住徐州医科大学附属医院ICU的患者。依据是否合并创伤性脑损伤(traumatic brain injury,TBI)将患者分为TBI组与非TBI组。观察创伤后早期血糖波动,包括应激性高血糖(stress-induced hyperglycemia,SIH)、入院初次血糖值、血糖极值以及短期血糖变异性(glycemic variability,GV)等相关指标,并应用72 h血糖变异系数(glucose coefficient of variation,Glu-CV)反映短期GV。1个月后使用PTSD检查量表(the PTSD checklist for DSM-5,PCL-5)评估患者PTSD症状,以PCL-5得分38分为界将患者分为PTSD组与非PTSD组。比较各组患者的早期血糖波动情况;采用Logistic回归分析PTSD发病的影响因素;绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估相关指标对PTSD发病的预测价值。结果共纳入159例急性多发伤患者,其中TBI组94例,非TBI组65例。TBI组PTSD发生率、PCL-5量表得分、SIH发生率以及72 h Glu-CV均高于非TBI组,差异有统计学意义(均P<0.05)。PTSD组中SIH发生率以及Glu-CV均高于非PTSD组,差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示72 h Glu-CV(OR=1.333,95%CI:1.028~1.727,P=0.030)是急性多发伤后发生PTSD的独立危险因素。ROC曲线下面积为0.861(95%CI:0.789~0.933,P<0.001),敏感度为62.9%,特异度为93.5%。结论合并TBI的急性多发伤患者更易出现早期血糖波动以及发生PTSD,且短期血糖变异性增加是急性多发伤后发生PTSD的独立危险因素。Objective To investigate the impact of early blood glucose fluctuations after acute multiple injuries on post-traumatic stress disorder(PTSD).Methods This study was a case-control study.From March 2022 to March 2023,patients with acute multiple injuries who were admitted to the ICU of the Affiliated Hospital of Xuzhou Medical University were selected.According to whether complicated with traumatic brain injury(TBI),the patients were divided into TBI group and non-TBI group.Early post-traumatic blood glucose fluctuations were observed,including stress-induced hyperglycemia(SIH),initial blood glucose value on admission,blood glucose extreme,short-term glycemic variability(GV)and other related indicators.The 72-hour glucose coefficient of variation(Glu-CV)was used to reflect short-term GV.After 1 month,the PTSD checklist for DSM-5(PCL-5)was used to assess the patient's symptoms of PTSD.The patients were divided into PTSD group and non-PTSD group according to PCL-5 score≥38.The differences in short-term glucose fluctuations in each groups were compared;the risk factors of PTSD were analyzed by logistic regression;the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of related indicators on the incidence of PTSD.Results 159 patients with acute multiple injuries were selected and defined as the TBI group(n=94)and non-TBI group(n=65).The incidence of PTSD,PCL-5 scale scores,the incidence of SIH and 72 h Glu-CV in the TBI group were significantly higher than the non-TBI group(all P<0.05).The incidence of SIH and 72 h Glu-CV in the PTSD group were significantly higher than the non-PTSD group(both P<0.05).Multivariate logistic regression analysis showed that 72 h Glu-CV(OR=1.333,95%CI:1.028-1.727,P=0.030)was the independent risk factor for PTSD after acute multiple injuries,and the area under the ROC curve was 0.861(95%CI:0.789-0.933,P<0.001),the sensitivity was 62.9%and the specificity was 93.5%.Conclusion Patients with acute multiple injuries with TBI are more likely to have earl

关 键 词：创伤后应激障碍 急性多发伤 创伤性脑损伤 脑葡萄糖代谢紊乱 应激性高血糖 血糖变异性 PCL-5评分 

分 类 号：R749.5[医药卫生—神经病学与精神病学]