摘要
目的回顾性分析平均血糖波动幅度（MAGE）对严重烧伤患者预后的意义。方法选择2011年1月-2014年8月无锡市第三人民医院烧伤科收治的符合人选标准的76例严重烧伤患者，统计其人口学、伤情、治疗情况等资料；监测其入院后72h内血糖，计算MAGE。（1）根据伤后90d内死亡情况，将患者分为存活组46例和死亡组30例，比较2组患者MAGE水平。（2）根据人院后72h内MAGE的三分位水平，将患者分为低分位组（MAGE〈3．3mmol／L）26例、中分位组（MAGE为3．3～5．5mmol／L）27例、高分位组（MAGE〉5．5mmol／L）23例，绘制Kaplan—Meier生存曲线比较3组患者伤后90d内存活率及存活时间。对数据行t检验、单因素方差分析、LSD检验、x2检验或Fisher确切概率法检验；对生存曲线行Log—rank检验；对人口学资料、急性生理与慢性健康评估Ⅱ评分、伤情、治疗情况、脓毒症、ICU住院时间、MAGE与患者死亡进行单因素及多因素Cox回归分析；绘制76例患者MAGE的受试者工作特征（ROC）曲线，分析其对死亡的预测价值。结果死亡组患者伤后72h内MAGE水平为（6．0±1．4）mmol／L，显著高于存活组的（3．5±1．2）mmol／L，t=9．219，P=0．004。低分位组、中分位组、高分位组患者伤后90d内存活率分别为88．5％（23／26）、59．3％（16／27）和30．4％（7／23），3组差异明显（X2=18．073，P〈0．001）；低分位组患者存活时间为（83±21）d，显著长于中分位组的（63±34）d（P〈0．05），2组存活时间均显著长于高分位组的（46±37）d（尸值均小于0．05）。烧伤总面积、脓毒症、血液净化治疗和MAGE是影响患者死亡的独立危险因素（风险比分别为4．324、1．591、1．886、2．047，95％置信区间分别为2．978～6．119、1．005～1．657、1．614～2．408、1．852—3．161，P〈0．05或P〈0．01）。对76例患者死亡预测的MAGE的ROC曲线下面积为0．870（95％置信区间为0．786～0．966，P〈0．001），4．7mmol／L为MAGE的最佳阈值，其对死亡预测的敏感度为86．7％、特异度为89．1％。结论MAGE与严重烧伤患者的预后密切相关，MAGE水平高则提示预后不佳，通过监测MAGE来控制血糖波动可能有助于降低患者病死率。
Objective To retrospectively analyze the prognostic significance of mean amplitude of glycemic excursion （MAGE） in patients with severe burn. Methods A study involving 76 patients with severe burn admitted into Department of Burns of the Third People＇s Hospital of Wuxi City from January 2011 to August 2014, conforming to the inclusion criteria was conducted. Data of their demography, injury, and treatment were collected. Blood glucose level of patients was measured during the first 72 h after admission, and MAGE was calculated. （1） The patients were divided into survival group （ n --46） and death group （ n = 30） according to the outcome within post injury day （PID） 90. The MAGE level of patients was com- pared between two groups. （2） The patients were divided into 3 groups by tertiles of MAGE within 72 h after admission, with 26 cases in low tertile group （ MAGE 〈 3. 3 mmol/L） , 27 eases in middle tertile group （with MAGE from 3.3 to 5.5 mmol/L） , 23 cases in high tertile group （MAGE 〉 5.5 mmol/L）. The survi- ving curve was drawn using the Kaplan-Meier method to compare survival rates and surviving time of patients among the 3 groups within PID 90. Data were processed with t test, one-way analysis of variance, LSD test, chi-square test, and Fisher＇s exact test. The surviving curve was analyzed by the Log-rank test. Correlation was analyzed between demography, acute physiology and chronic health evaluation Ⅱ score, injury, treat- ment, sepsis, length of ICU stay, MAGE and death of patients using the univariate and multivariate Cox re- gression analysis. Receiver operating characteristic （ROC） curve of MAGE was drawn to predict death for 76 patients. Results Within 72 h after admission, the MAGE of patients in death group was （6.0 ± 1.4） mmol/L, which was significantly higher than that in survival group [ （3. 5 ± 1. 2） mmol/L, t = 9. 219, P = 0. 0041. The survival rates of patients in low tertile, middle tertile, and high tertile groups with- in PID 90 were respectively 88.5% （23/26）, 59.3% （ 16/27 ）, and 30.4% （7/23）, with significant differences among 3 groups （X 2 = 18. 073, P 〈0. 001 ）. The surviving time of patients in low tertile group [ （83 ±21） d] was significantly longer than that of middle tertile group [ （63 ±34） d, P 〈 0.05]. The surviving time of patients was longer in low tertile and middle tertile groups than in high tertile group [ （46 ± 37） d, with P values below 0.051. Total burn area, sepsis, blood purification, and MAGE were independ- ent risk factors of death （with hazard ratio respectively 4. 324, 1. 591, 1. 886, 2. 047 ; 95% confidence in- terval respectively 2. 978-6. 119, 1.005 -1.657, 1.614-2.408, 1.852 -3. 161; P 〈0.05 orP 〈 0.01 ）. The area under the ROC curve of MAGE for predicting death for 76 patients was 0. 870 （with 95% confidence interval 0. 786 - 0. 966, P 〈 0. 001 ） , and 4.7 mmol/L was chosen as the optimal threshold val- ue, with sensitivity of 86.7% and specificity of 89, 1%. Conclusions The increase of MAGE in patients with severe burn is significantly associated with poor prognosis; controlling the glucose level fluctuation guided by measuring MAGE may be helpful in reducing mortality of patients.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2016年第1期35-39,共5页
Chinese Journal of Burns
关键词
烧伤
血糖
预后
Burns
Blood glucose
Prognosis
