重症胰腺炎患者血糖异常波动程度与28天病死率之间的相关性分析
Correlation between glucose fluctuation index and 28 day mortality in patients with severe acute pancreatitis

祁玮.重症胰腺炎患者血糖异常波动程度与28天病死率之间的相关性分析[J].内科急危重症杂志,2019,25(3):210-212

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DOI：10.11768/nkjwzzzz20190310

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作者	单位	E-mail
祁玮	泰康仙林鼓楼医院	qiweixianlingulo@sohu.com

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中文摘要:

目的：探讨重症急性胰腺炎（SAP）患者血糖异常波动程度与28d病死率之间的相关性。方法：选取59例SAP患者，监测其血糖的波动情况。血糖波动评价指标包括入组时初始血糖（BGad）、24h平均血糖（BGm）及其标准差（BGsd）、血糖变异系数（BGcv）、血糖不稳定指数（BGI）。病情危重程度评价指标包括急性生理与慢性健康状况评分（APACHE Ⅱ）、改良早期预警评分（MEWS）、简化急性生理学评分（SAPS Ⅲ）、序贯器官衰竭评分（SOFA）以及快速序贯器官衰竭评分（qSOFA）。根据28d时的临床结局，分为死亡组(21例)和存活组(38例)。比较2组的血糖波动情况。结果：死亡组SAP患者接受肾脏替代治疗比例、机械通气时间和ICU滞留时间均明显高于存活组（均P<0.05）。死亡组患者BGsd\[（2.53±0.68)mmol/L vs (1.72±0.15)mmol/L，P=0.003\],BGcv(46.61%±7.35% vs 21.93%±5.22%，P<0.001)和BGI\[（12.96±2.05）mmol/(L2•h•d) vs （5.57±1.09）mmol/(L2•h•d) ，P<0.001\]水平均明显高于存活组患者。ROC曲线分析提示BGcv和BGI对于28d死亡事件的早期预测AUC分别为0.849和0.824，其中BGcv的截断值为53.4%，敏感性为86.3%，特异性为81.5%；BGI的截断值为15.4mmol/(L2•h•d)，敏感性为83.4%，特异性为80.7%。〖JP2〗相关性分析提示BGcv（r=0.685，P<0.001）和BGI（r=0.692，P<0.001）均与28d死亡事件呈正相关。结论：BGcv和BGI可以更有效地早期预测SAP患者的28d死亡事件。

英文摘要:

Objective: To evaluate the correlation between glucose fluctuation index and 28day mortality in patients with severe acute pancreatitis (SAP). Methods: A total of 59 SAP patients were enrolled in this study and divided into two group: death group (n=21) and survival group (n=38). The glucose fluctuation was monitored, and the glucose fluctuation indexes including: BGad, BGm, BGsd, BGcv and BGI. The critical illness scores (APACHE Ⅱ, MEWS, SAPS Ⅲ, SOFA and qSOFA) were recorded. Results: The CRRT rate, mechanism ventilation and ICU hospital days in death group were significantly increased as compared with those in survival group (P<0.05). The levels of BGsd \[(2.53±0.68) vs (1.72±0.15)mmol/L, P=0.003\], BGcv (46.61%±7.35% vs 21.93%±5.22%, P<0.001) and BGI \[(12.96±2.05) mmol/(L2•h•d) vs (5.57±1.09) mmol/(L2•h•d), P<0.001\] in death group were significantly higher than those in survival group. ROC analysis showed the AUC of BGcv and BGI for 28day mortality was 0.849 and 0.824, respectively. Correlation analysis suggested that BGcv (r=0.685, P<0.001) and BGI (r=0.692, P<0.001) were positively associated with 28day mortality. Conclusion: BGcv and BGI may be promising markers for early predicting 28day mortality in SAP patients.