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血糖变异性参数在重症新型冠状病毒肺炎患者预后判断中的价值
引用本文:胡森安,谭俊锋,彭昌,艾红红,李丹.血糖变异性参数在重症新型冠状病毒肺炎患者预后判断中的价值[J].检验医学,2021(4):400-403.
作者姓名:胡森安  谭俊锋  彭昌  艾红红  李丹
作者单位:佛山市高明区人民医院检验科;佛山市高明区人民医院呼吸内科
摘    要:目的探讨血糖变异性参数在判断重型和危重型(统称为重症)新型冠状病毒肺炎(COVID-19)患者预后中的价值。方法收集83例重症COVID-19患者的一般资料、转入ICU时的急性生理与慢性健康评分Ⅱ(APACHEⅡ)、72 h内的动态血糖变异性参数平均血糖波动幅度(Glu-MAGE)、血糖变异系数(Glu-CV)、血糖不稳定指数(Glu-GLI)及72 h平均血糖]。根据患者28 d内的预后情况分为生存组和死亡组。根据患者72 h监测的平均血糖,以11.1、7.8 mmol/L为临界值分为>11.1 mmol/L组、7.8~11.1 mmol/L组和<7.8 mmol/L组。根据72 h Glu-CV结果,按四分位法将所有患者分为4个组(Q1组~Q4组),再根据有无糖尿病史分为无糖尿病组和糖尿病组。比较各组的血糖变异性参数及死亡率。结果死亡组年龄、APACHEⅡ评分、72 h平均血糖、Glu-MAGE、Glu-GLI、Glu-CV显著高于生存组(P<0.05)。>11.1 mmol/L组Glu-MAGE、Glu-CV均高于7.8~11.1 mmol/L组和<7.8 mmol/L组(P<0.05),而7.8~11.1 mmol/L组与<7.8 mmol/L组之间差异均无统计学意义(P>0.05),其他项目3个组之间差异均无统计学意义(P>0.05);28 d病死率随血糖水平的升高而升高,3组间差异均有统计学意义(P<0.05)。在Q1组~Q4组中,糖尿病患者的28 d死亡率均高于无糖尿病患者(P<0.05)。无论是否有糖尿病,患者的28 d死亡率均随着Glu-CV的升高而升高(P<0.05)。结论重症COVID-19患者的死亡风险有随血糖变异增大而升高的趋势。

关 键 词:血糖变异性参数  新型冠状病毒肺炎  预后

Role of blood glucose variability in the prognosis of severe corona virus disease 2019 patients
HU Senan,TAN Junfeng,PENG Chang,AI Honghong,LI Dan.Role of blood glucose variability in the prognosis of severe corona virus disease 2019 patients[J].Laboratory Medicine,2021(4):400-403.
Authors:HU Senan  TAN Junfeng  PENG Chang  AI Honghong  LI Dan
Institution:(Department of Clinical Laboratory,the People's Hospital of Gaoming District,Foshan 528500,Guangdong,China;Department of Respiratory Medicine,the People's Hospital of Gaoming District,Foshan 528500,Guangdong,China)
Abstract:Objective To investigate the role of blood glucose variability in the prognosis of patients with severe and critical(collectively referred to as severe)corona virus disease 2019(COVID-19)patients.Methods The general data of 83 patients with severe COVID-19 were collected,and acute physiological and chronic health evaluationⅡ(APACHEⅡ)score when transferred to intensive care unit(ICU),dynamic glucose variability data within 72 hmean glucose fluctuation amplitude(Glu-MAGE),glucose-coefficient of variation(Glu-CV),glucose instability index(Glu-GLI)and 72 h mean glucose]were recorded.According to the prognosis of 28 d,the patients were classified into survival group and death group.According to the patients'average 72 h blood glucose,the cut-off values of 11.1 and 7.8 mmol/L,the patients were classified into>11.1 mmol/L,7.8-11.1 mmol/L and<7.8 mmol/L groups.Based on the results 72 h Glu-CV,the patients were classified into 4 groups by quartiles(Q1-Q4).According to the history of diabetes,the patients were classified into non-diabetic group and diabetic group.Blood glucose variability and mortality were compared in each group.Results The age,APACHEⅡscore,72 h mean glucose,Glu-MAGE,Glu-GLI,Glu-CV of death group were higher than those of survival group(P<0.05).In the>11.1 mmol/L group,Glu-MAGE,Glu-CV were higher than those in 7.8-11.1 mmol/L and<7.8 mmol/L groups(P<0.05).There was no statistical significance between 7.8-11.1 mmol/L group and<7.8 mmol/L group(P>0.05).The other items were not statistically significant among the 3 groups(P>0.05).The 28 d mortality increased with the increase of blood glucose,and the difference among the 3 groups had statistical significance(P<0.05).In Q1-Q4 groups,the 28 d mortality rate of 28 d of diabetic patients was higher than that of nondiabetic patients(P<0.05).With or without diabetes,the 28 d mortality rate increased with the increase of Glu-CV(P<0.05).Conclusions Death risk in patients with severe COVID-19 increases with the increasing of blood glucose variability.
Keywords:Glucose variability  Corona virus disease 2019  Prognosis
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