CAJ | 학술논문

目的评估血糖不稳定指数(GLI)作为血糖波动的指标对重症监护病房(ICU)危重症患者转归的预测价值.方法观察72例危重症患者入ICU 24 h内每2h的血糖情况,计算血糖GLI,日内平均血糖波动幅度(MAGE),最大血糖波动幅度(LAGE),平均值(MEAN),标准差(SD),变异系数(CV)；观察患者30 d转归；应用受试者工作特征曲线(ROC曲线)评估各指标与预后的相关性.根据MEAN和GLI的中位数分为4个亚组,比较各亚组间30 d病死率.结果 72例患者中31例死亡,总体病死率为43.1％.GLI的ROC曲线下面积(AUC)(0.798±0.051)优于MAGE(0.785±0.053),LAGE(0.772 ±0.056),SD(0.761±0.056),CV(0.729±0.059)及MEAN(0.670±0.065)的AUC.GLI与入ICU 24 h内APACHEⅡ评分显著相关(R2=0.787,P＜0.001).亚组分析显示,低MEAN+低GLI组呼吸机撤机时间、CRRT使用率、ICU入住时间和30 d病死率分别为(3.3±4.4)d,41.6％,12.5％,(4.6±4.5)d,16.7％较其他3组明显降低,其预后最佳,高MEAN+高GLI组预后最差.结论入ICU 24 h内GLI作为血糖波动的指标与危重症患者预后显著相关.
목적 평고혈당불은정지수(GLI)작위혈당파동적지표대중증감호병방(ICU)위중증환자전귀적예측개치.방법 관찰72례위중증환자입ICU 24 h내매2h적혈당정황,계산혈당GLI,일내평균혈당파동폭도(MAGE),최대혈당파동폭도(LAGE),평균치(MEAN),표준차(SD),변이계수(CV)；관찰환자30 d전귀；응용수시자공작특정곡선(ROC곡선)평고각지표여예후적상관성.근거MEAN화GLI적중위수분위4개아조,비교각아조간30 d병사솔.결과 72례환자중31례사망,총체병사솔위43.1％.GLI적ROC곡선하면적(AUC)(0.798±0.051)우우MAGE(0.785±0.053),LAGE(0.772 ±0.056),SD(0.761±0.056),CV(0.729±0.059)급MEAN(0.670±0.065)적AUC.GLI여입ICU 24 h내APACHEⅡ평분현저상관(R2=0.787,P＜0.001).아조분석현시,저MEAN+저GLI조호흡궤철궤시간、CRRT사용솔、ICU입주시간화30 d병사솔분별위(3.3±4.4)d,41.6％,12.5％,(4.6±4.5)d,16.7％교기타3조명현강저,기예후최가,고MEAN+고GLI조예후최차.결론 입ICU 24 h내GLI작위혈당파동적지표여위중증환자예후현저상관.
Objective To access the predictive values of glycemic lability index(GLI)as an indicator of glucose variability in the prognosis of critically ill patients.Methods A prospective study of 72 critically ill patients admitted into intensive care unit(ICU)were performed.Capillary glucose was measured on admission and every 2 hrs afterward during the first 24 hrs.GLI,mean amplitude of glycemic excursion(MAGE),largest amplitude of glycemic excursions(LAGE),mean,standard deviation(SD)and coefficient of variability(CV)were calculated respectively.The 30 day mortality was selected as the end-point.Receiver operating curve(ROC)was drawn to explore the association between each indicator of glucose variability and prognosis.The subjects were subsequently divided into 4 subgroups according to the median of mean and GLI.The 30-day mortality was then compared between the subgroups.Results Thirtyone of 72 patients died with a mortality rate of 43.1％.The area under the curve(AUC)of GLI(0.798 ±0.051)was superior to that of MAGE(0.785 ±0.053),LAGE(0.772 ±0.056),SD(0.761 ±0.056),CV(0.729 ± 0.059)and mean(0.670 ± 0.065)under the determination of ROC respectively.GLI was significantly correlated with APACHE Ⅱ(acute physiology and chronic health evaluation Ⅱ)score assessed during the first 24 hrs after admission(R2 =0.787,P ＜ 0.001).With the rise of GLI value,the 30-day mortality also increased gradually.Subgroup analysis demonstrated that the duration of mechanical ventilation,the incidence of multiple organ failure(MOF),the utilization rate of CRRT(continuous renal replacement therapy),the staying length of ICU and the 30 mortality rate was(3.3 ±4.4)d,41.6％,12.5％,(4.6 ± 4.5)d and 16.7％ respectively in the low mean + low GLI subgroup.They decreased obviously compared to the low mean + high GLI,high mean + low GLI and high mean + high GLI groups.Therefore the low mean + low GLI subgroup had the best prognosis while the high mean + high GLI subgroup worst.Conclusion GLI of the first 24hrs after ICU admission can serve as an indictor of glucose variability.And it is significantly correlated with the patient prognosis.