严重脓毒症患者血糖波动与hs-CRP、PCT、IL-6水平的相关性

目的：探讨严重脓毒症患者血糖波动与血清高敏C反应蛋白(hs-CRP)、降钙素原(PCT)及白细胞介素6(IL-6)水平的关系。方法选取2013年3月至2015年3月在我院治疗的严重脓毒症患者102例，依据72 h内平均血糖波动幅度(MAGE)分为A组(MAGE<3.9 mmol/L，62例)、B组(MAGE≥3.9 mmol/L，40例)。入组患者24 h内进行急性生理学及慢性健康状况Ⅱ评分(APACHEⅡ)、同时监测72 h MAGE，检测第1、3、5天hs-CRP、IL-6及PCT水平。对72 h MAGE与血清hs-PCR、IL-6、PCT水平进行Pearson直线相关分析。结果 B组24 h APACHEⅡ评分为(21.45±3.58)分，显著高于A组的(16.46±2.16)分(P<0.05)；B组72 h MAGE水平为(3.06±0.57) mmol/L，显著高于A组的(1.02±0.31) mmol/L (P<0.05)。B组血清hs-CRP、IL-6及PCT水平各时间点均高于A组(P<0.05)。72 h MAGE与血清hs-PCR、IL-6、PCT水平均呈正相关性(rhs-CRP=0.52，rIL-6=0.67，rPCT=0.50，P均<0.05)。结论严重脓毒症患者多存在较大幅度的血糖波动，且血清hs-CRP、IL-6、PCT呈高水平波动，72 h MAGE与血清hs-CRP、IL-6、PCT呈正相关性。因此推测血糖波动可能通过炎症反应介导而对机体产生损伤作用。

Correlation between glucose fluctuations with hs-CRP,PCT, IL-6 level in patients with severe sepsis

Objective To explore the relationship between glucose fluctuations with serum inflammatory fac-tors. Methods A total of 102 cases of severe sepsis patients, who admitted to our hospital from March 2013 to March 2015, were selected and divided into group A (n=62, MAGE<3.9 mmol/L) and group B (40 patients, MAGE≥3.9 mmol/L) according to mean amplitude of glucemic excursions (MAGE) in 72 h. Acute physiology and chronic health evaluation (APACHEⅡ) score was evaluated in 24 h. At the same time, MAGE was detected in 72 h, and high-sensitivity C-reac-tive protein (hs-CRP), interleukin-6 (IL-6) and procalcitonin (PCT) were detected at 1 d, 3 d and 5 d. These data was an-alyzed by Pearson linear correlation. Results APACHEⅡscore in 24 h and MAGE in 72 h in group of (21.45 ± 3.58) and (3.06 ± 0.57) mmol/L were significantly higher than those of group A of (16.46 ± 2.16) and (1.02 ± 0.31) mmol/L (P<0.05). At all corresponding time points, serum hs-CRP, PCT, IL-6 levels of the group A were significantly higher than those of the group B (P<0.05). 72 h MAGE had the positive correlation with serum hs-CRP, PCT and IL-6 (rhs-CRP=0.52, rIL-6=0.67, rPCT=0.50, P<0.05). Conclusion There are abnormal glucose fluctuations in many patients with severe sepsis, and 72 h MAGE has positive correlation with inflammatory factors. So it indicates that glucose fluctuations damage ef-fect may be mediated through inflammatory reaction.