摘要
目的探讨糖尿病合并重症肺部感染病人不同病原微生物血清及肺泡灌洗液中炎症因子的变化及意义。方法选取2016年1月—2017年4月我院收治的糖尿病合并重症肺部感染病人132例,根据血清及肺泡灌洗液中病原微生物的不同分为革兰阳性菌组、革兰阴性菌组和真菌组3个亚组,再根据病人的不同结局分为死亡组和存活组。应用动态血糖监测仪每2~4h监测1次血糖,计算全天血糖标准差(SDBG)。观察病人不同病原微生物血清和肺泡灌洗液中炎症因子,如白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)的变化,比较不同预后病人入院时APACHEⅡ评分、血糖达标时间、SDBG以及低糖血症事件情况。结果入院第1、7天革兰阴性菌感染病人血清和肺泡灌洗液中各炎症因子的水平最高,革兰阳性菌感染病人次之,真菌感染病人中最低,差异均有显著性(F=7.043~19.635,P<0.05)。入院第7天同种病原微生物感染病人血清和肺泡灌洗液中各炎症因子水平较第1天均明显下降(t=4.67~11.16,P<0.05)。不同结局的两组病人中,革兰阴性菌和革兰阳性菌感染的构成比比较,差异无显著性(P>0.05),而真菌感染构成比比较,差异有显著意义(χ2=25.097,P<0.05)。对影响病人的死亡因素进行Logistic回归分析显示,入院时APACHEⅡ评分(OR=2.342)、SDBG(OR=1.458)和真菌感染(OR=3.689)为病人死亡的独立危险因素。结论对糖尿病合并重症肺部感染病人进行血糖控制,降低全天血糖波动性,避免和控制真菌感染,有利于病人预后。
Objective To investigate the changes in inflammatory factors in serum and bronchoalveolar lavage fluid with different pathogenic bacteria and their clinical significance in patients with diabetes complicated by severe pulmonary infection.Methods A total of 132 patients with diabetes complicated by severe pulmonary infection who were admitted to our hospital from January 2016 to April in 2017 were enrolled.According to the pathogenic bacteria in serum and bronchoalveolar lavage fluid,the patients were divided into Gram-positive group,Gram-negative group,and fungal group;according to the clinical outcome,the patients were divided into death group and survival group.A continuous glucose monitoring system was used for the monitoring of blood glucose every 2-4 hours,and the standard deviation of blood glucose（SDBG）was calculated.The changes in inflammatory factors in serum and bronchoalveolar lavage fluid with different pathogenic bacteria were observed,including interleukin-6,interleukin-8,tumor necrosis factor-α,and C-reactive protein.The APACHEII score,time to reach blood glucose control target,SDBG,and hypoglycemic events were compared between the patients with different outcomes.Results On days 1 and 7 of hospitalization,the Gram-negative group had the highest levels of inflammatory factors in serum and bronchoalveolar lavage fluid,followed by the Gram-positive group and the fungal group,and there were significant differences between the three groups（F =7.043-19.635,P〈0.05）.On day 7 of hospitalization,the patients with infection caused by the same pathogenic bacteria had significant reductions in the levels of inflammatory factors in serum and bronchoalveolar lavage fluid（t=4.67-11.16,P〈0.05）.There were no significant differences in the constituent ratios of infections caused by Gram-negative and Gram-positive bacteria between the death group and the survival group（P〈0.05）,while there was a significant difference in the constituent ratio of fungal infection（χ^2=25.097,P〈0.05）.The logistic regression analysis of influencing factors for death showed that APACHEⅡscore（OR=2.342）,SDBG（OR=1.458）,and fungal infection（OR=3.689）were independent risk factors for death.Conclusion Blood glucose control for patients with diabetes complicated by severe pulmonary infection can reduce blood glucose fluctuation throughout the day,avoid and control fungal infection,and bring benefits to patients＇ prognosis.
作者
刘曙艳
周雪红
LIU Shuyan;ZHOU Xuehong(Department of Endocrinology, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo 454000, Chin)
出处
《齐鲁医学杂志》
2017年第5期590-593,共4页
Medical Journal of Qilu
