糖尿病对老年肺炎患者感染及心功能的影响  

Influence of Diabetes on Infection and Cardiac Function in Elderly Patients with Pneumonia

作　　者：康琦 曹一凡 原源 田巍 刘子琦 殷子樵 KANG Qi;CAO Yifan;YUAN Yuan(Department of Geriatrics,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院老年医学科,100035 [2]数学信息与行为教育部重点实验室、未来区块链与隐私计算高精尖中心、北京航空航天大学人工智能学院,100191 [3]软件开发环境国家重点实验室,北京100191 [4]中关村实验室,北京100194 [5]北京航空航天大学数学科学学院,100191

出　　处：《医学研究杂志》2025年第3期28-33,共6页Journal of Medical Research

基　　金：国家重点研发计划项目(2020YFC2005403);国家自然科学基金资助项目(12201025)。

摘　　要：目的利用LASSO回归在复杂疾病早筛、病情判断上的优势,寻找老年社区获得性肺炎(community-acquired pneumonia,CAP)合并糖尿病(diabetes mellitus,DM)患者心功能不全和感染程度的早期评价工具,以期指导临床。方法根据入院指标对住院期间指标最大值及出院时指标进行多因素联合分析,对比老年CAP合并DM(CAP+DM)与老年CAP不合并DM(单纯CAP)患者核心特征指标的差异;讨论生化指标对于两组患者核心特征指标发展预测的必要性。结果老年CAP+DM患者入院时血白细胞计数越高,住院期间氨基末端脑钠肽前体(N terminal-pro B type natriuretic peptide,NT-pro BNP)、尿白细胞计数最大值越大;入院时尿白细胞计数越高,住院期间血白细胞计数、尿白细胞计数最大值越大;通过老年CAP患者入院时NT-pro BNP、血常规、尿常规指标,对核心指标住院期间最大值及出院时水平进行LASSO回归,发现加入生化指标后,住院期间NT-pro BNP、尿白细胞计数最大值及出院时NT-pro BNP水平的决定系数均显著升高。结论老年CAP+DM患者,入院时血白细胞水平可作为住院期间心功能不全严重程度的预测指标。对于入院时血白细胞计数、尿白细胞计数高的老年CAP+DM患者,住院期间要筛查是否合并泌尿系感染。入院时完善生化指标可以有效地帮助老年CAP患者判断住院期间心功能不全和泌尿系感染严重程度及出院时心功能的情况。Objective Using the advantages of LASSO regression in early screening of complex diseases and judging disease conditions,to search a tool for early evaluation of cardiac insufficiency and infection in elderly people with community-acquired pneumonia(CAP)combined with diabetes mellitus(DM)to guide clinical practice.Methods According to the levels of the indexes at admission,the maximum level of the indexes during hospitalization and the level of the indexes at discharge were analyzed by multivariate analysis,and the differences of the core characteristic indexes were compared between the elderly patients with CAP combined with DM(CAP+DM)and those with CAP without DM(CAP alone)to discuss the necessity of biochemical indicators for predicting the development of core characteristics of two groups of patients.Results In elderly CAP+DM patients,the higher level of the blood white blood cell count at admission,the maximum levels of N terminal-pro B type natriuretic peptide(NT-pro BNP)and urine white blood cell count during hospitalization were higher.The higher the urine white blood cell count at admission,the maximum levels of blood white blood cell count and urine white blood cell count during hospitalization were higher.According to the NT-pro BNP,blood routine,and urine routine indexes at admission of elderly CAP patients,LASSO regression was performed on the maximum levels of core indexes during hospitalization and the levels of core indexes at discharge.It was found that after adding biochemical indexes,the determination coefficients of maximum levels of NT-pro BNP and urine white blood cell count during hospitalization and the NT-pro BNP level at discharge were significantly increased.Conclusion In elderly CAP+DM patients,the level of blood white blood cell count at admission can be used as a predictor of the severity of cardiac insufficiency during hospitalization.For elderly CAP+DM patients with higher blood white blood cell count and urine white blood cell count,attention should be paid to screen urinary tract

关 键 词：LASSO回归 老年社区获得性肺炎 糖尿病 心功能不全 泌尿系感染 

分 类 号：R563[医药卫生—呼吸系统] R587[医药卫生—内科学]