中国实用儿科杂志

中国实用儿科杂志

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不同年龄危重患儿血糖波动与预后关系的研究

  

  1. 1.郑州大学附属儿童医院  河南省儿童医院  郑州儿童医院内科监护室，河南  郑州  450000； 2.重庆医科大学附属儿童医院重症医学科  儿童发育疾病研究教育部重点实验室  国家儿童健康与疾病临床医学研究中心（重庆）  儿童发育重大疾病国家国际科技合作基地  儿科学重庆市重点实验室，重庆  400014
  • 出版日期:2020-06-06 发布日期:2020-07-03

Relationship between glycaemic variability and outcomes in critically ill children at different age

  1. *Internal ICU，Children’s Hospital Affiliated to Zhengzhou University，Henan Children’s Hospital，Zhengzhou Children’s Hospital，Zhengzhou  450000，China
  • Online:2020-06-06 Published:2020-07-03

摘要： 目的　探讨不同年龄危重患儿血糖波动对其预后的预测价值， 观察年龄对血糖波动与病死率的影响。方法　回顾性收集2016年1月1日至2016年12月31日重庆医科大学附属儿童医院重症医学科（PICU） 410例危重患儿的资料， 以入 PICU 后 28 d 转归情况分为生存组和死亡组， 记录入住PICU后72 h生理参数及结局资料，运用单因素、 相关性、 受试者工作特征（ROC）曲线及Logistic回归分析等统计学方法进行统计分析。结果　（1）不同血糖波动指标中，血糖不稳定指数（GLI）对预后具有更好的评价效能［GLI： r＝0.404， P＜0.001； 曲线下面积（AUC）＝0.626， 95%CI为0.558～0.693］。多因素Logistic回归分析亦显示： 调整了疾病构成比、 严重程度及平均血糖， GLI是PICU死亡的独立危险因素（OR＝1.069， 95%CI为1.018～1.122， P＜0.01）。（2）与成人不同， 儿童血糖波动存在不均质性， 年龄更小的患儿（小于36月龄组）在最低平均血糖、 最高血糖波动组有更高的病死率（71.4%）， 而年龄更大的患儿（大于36月龄组）在最高平均血糖及血糖波动组病死率更高（69.2%）。结论　危重患儿血糖波动增加病死率， GLI比其他血糖波动参数对死亡风险的预测能力更好。该研究首次表明儿童血糖波动对预后的影响存在年龄差异性影响， 不同年龄血糖波动对预后影响有差异。

关键词: 血糖, 危重患儿, 年龄, 病死率

Abstract: Objective　To compare the ability of different indices of glycemic variability（GV） in the prognostic evaluation of critically ill children and investigate the effect of age in GV and mortality. Methods　A retrospective study of 410 patients was conducted admitted to the medical-surgical PICU of a teaching hospital from January 2016 to December 2016. The patients were divided into survivors or non-survivors according to the 28 days physical condition after PICU admission. Physiological parameters and outcome data were recorded for 72 h after PICU admission，a variety of statistical methods were used for statistical analysis, including the univariate, spearman correlation，receiver operating characteristic（ROC） curve and logistic regression analysis and so on. Results　（1）Survivors and non-survivors showed significant differences in terms of the SD，CV，MAGE，and GLI（ P＜0.05，for all）. However，GLI was superior to the other indices（GLI：r＝0.404， P＜0.001；AUC＝0.626，95%CI＝0.558～0.693），and showed an independent association with ICU mortality（OR＝1.069，95%CI＝1.018～1.122，P＜0.01. （2）Different from adult  studies, there is a heterogeneous effect of GV in children, sub-group analysis disaggregated by quartiles of MGL and GV revealed that younger subjects（age ≤36 months） in the lowest quartile of the MGL and in the highest quartile of GV had significantly higher mortality（71.4%）；the older children（age＞36 months）  in the highest quartiles of MGL and GV experienced higher mortality（69.2%）. Conclusion　GV increased the risk of mortality in critically ill children，and among all glucose parameters evaluated，GLI was found to be the strongest predictor of outcomes. This study is the first report showing that there is a heterogeneous effect of GV in different age groups in children.

Key words: blood glucose, critically ill children, age, mortality