应激性高血糖比值与慢性阻塞性肺疾病患者发生急性加重的关系:基于限制性立方样条模型  

Relationship between Stress Hyperglycaemia Ratio and Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease:Based on Restricted Cubic Spline Model

作　　者：乔梦圆 王海燕[2] 叶改花[2] 秦梦真 董钰莹 QIAO Mengyuan;WANG Haiyan;YE Gaihua;QIN Mengzhen;DONG Yuying(School of Nursing,Henan University of Science and Technology,Luoyang 471000,China;Emergency Center,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Shihezi University School of Medicine,Shihezi 832000,China)

机构地区：[1]河南科技大学护理学院,河南省洛阳市471000 [2]新疆维吾尔自治区人民医院急救中心,新疆维吾尔自治区乌鲁木齐市830000 [3]石河子大学医学院,新疆维吾尔自治区石河子市832000

出　　处：《实用心脑肺血管病杂志》2025年第5期26-31,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：“天山英才”医药卫生高层次培养计划项目(TSYC202301A085)。

摘　　要：目的探讨应激性高血糖比值(SHR)与慢性阻塞性肺疾病(COPD)患者发生急性加重的关系。方法回顾性收集2018—2023年在新疆维吾尔自治区人民医院就诊的COPD患者1580例。收集患者的临床资料,根据COPD患者发生急性加重情况将其分为急性加重组与非急性加重组。采用多因素Logistic回归分析探讨COPD患者发生急性加重的影响因素;采用ROC曲线分析SHR对COPD患者发生急性加重的预测价值;采用限制性立方样条模型分析SHR与COPD患者发生急性加重的剂量-反应关系。结果根据SHR将COPD患者分为Q1组(SHR≤0.76)、Q2组(0.76<SHR≤0.98)、Q3组(0.98<SHR≤1.50)、Q4组(SHR>1.50),每组395例。Q3组急性加重发生率高于Q1、Q2组,Q4组急性加重发生率高于Q1、Q2、Q3组(P<0.05)。1580例COPD患者发生急性加重333例。急性加重组与非急性加重组年龄、BMI、有吸烟史者占比、有糖尿病史者占比、有脑血管疾病史者占比、机械通气者占比、APACHEⅡ评分、血红蛋白(Hb)、C反应蛋白(CRP)、SHR比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BMI、吸烟史、糖尿病史、机械通气、APACHEⅡ评分和SHR是COPD患者发生急性加重的独立影响因素(P<0.05)。ROC曲线分析结果显示,SHR预测COPD患者发生急性加重的AUC为0.724〔95%CI(0.692~0.727)〕,最佳截断值为1.18,灵敏度为67.9%,特异度为70.2%。限制性立方样条模型显示,SHR与COPD患者发生急性加重的风险呈线性关系(P整体<0.001,P非线性=0.391)。结论SHR是COPD患者发生急性加重的独立影响因素,SHR对COPD患者发生急性加重有一定预测价值,SHR与COPD患者发生急性加重的风险呈线性关系。Objective To investigate the relationship between stress hyperglycaemia ratio(SHR)and acute exacerbation in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 1580 COPD patients in People's Hospital of Xinjiang Uygur Autonomous Region from 2018 to 2023 were retrospective selected.Clinical data of subjects were collected,and patients were divided into acute exacerbation group and non-acute exacerbation group according to acute exacerbation in patients with COPD.Multivariate Logistic regression analysis was used to explore the influencing factors for acute exacerbation in patients with COPD.ROC curve was used to explore the predictive value of the SHR for acute exacerbation in patients with COPD.Restricted cubic spline model was used to analyze the nonlinear relationship between SHR and acute exacerbation in patients with COPD.Results COPD patients were divided into Q1 group(SHR≤0.76),Q2 group(0.76<SHR≤0.98),Q3 group(0.98<SHR≤1.50),and Q4 group(SHR>1.50)based on SHR,with 395 cases in each group.The incidence of acute exacerbation in Q3 group was higher than that in Q1 group and Q2 group,the incidence of acute exacerbation in Q4 group were higher than those in Q1 group,Q2 group,and Q3 group(P<0.05).Among 1580 COPD patients,333 experienced acute exacerbation.There were significant differences in the age,BMI,proportion of patients with smoking history,proportion of patients with diabetes history,proportion of patients with cerebrovascular disease history,proportion of patients with mechanical ventilation APACHEⅡscore,hemoglobin(Hb),C-reactive protein(CRP),SHR between acute exacerbation group and non-acute exacerbation group(P<0.05).Multivariate Logistic regression analysis showed that BMI,smoking history,diabetes history,mechanical ventilation APACHEⅡscore,SHR were independent influencing factors for acute exacerbation in patients with COPD(P<0.05).ROC curve analysis showed that the AUC of SHR for predicting acute exacerbation in patients with COPD was 0.724[95%CI(0.692-0.727)],the

关 键 词：肺疾病 慢性阻塞性 应激性高血糖比值 急性加重 限制性立方样条模型 

分 类 号：R563.9[医药卫生—呼吸系统]