引用本文
  • 宋艳丽,陈子阳,吴先正,等.胰岛素抵抗指数在脓毒症患者预后评估中的价值[J].同济大学学报(医学版),2020,41(1):63-67,71.    [点击复制]
  • SONG Yan-li,CHEN Zi-yang,WU Xian-zheng,et al.The value of insulin resistance index in evaluation of prognosis in patients with sepsis[J].同济大学学报(医学版),2020,41(1):63-67,71.   [点击复制]
【打印本页】 【在线阅读全文】【下载PDF全文】 查看/发表评论下载PDF阅读器关闭

←前一篇|后一篇→

过刊浏览    高级检索

本文已被:浏览 6次   下载 13 本文二维码信息
码上扫一扫!
胰岛素抵抗指数在脓毒症患者预后评估中的价值
宋艳丽,陈子阳,吴先正,李嘉,戴国兴,张海霞
0
(同济大学附属同济医院急诊医学科,上海 200065)
摘要:
目的 探讨利用稳态模型测定的胰岛素抵抗指数(homeostasis model assessment insulin resistance index, HOMA-IR)在脓毒症患者预后评估中的价值。方法 采用回顾性队列研究,入选2016年5月—2018年1月同济大学附属同济医院EICU收治的脓毒症患者88例。收集所有患者详细的临床资料,入院24h内检测血清胰岛素(fasting insulin, FINS)、空腹血糖(fasting blood glucose, FBG)、降钙素原(procalcitonin, PCT)、血乳酸(blood lactic acid, Lac)、IL-6、IL8及TNF-α等血液生化指标。计算所有患者氧合指数(PaO2/FiO2)、急性生理学和慢性健康评分(acute physiology and chronic health evaluation, APACHE Ⅱ)和序贯器官衰竭评分(sequential organ failure assessment, SOFA)。运用稳态模式评估法(homeostasis model assessment, HOMA)计算HOMA-IR。住院期间死亡为观察终点。结果 88例脓毒症患者中生存68例,死亡20例。死亡组患者入院时的APACHE Ⅱ评分、SOFA评分、PCT、IL-6、IL-8、空腹血糖水平及HOMA-IR均明显高于生存组(P<0.05)。HOMA-IR与APACHE Ⅱ、SOFA、快速SOFA(qSOFA)评分呈明显正相关(r=0.311、0.268、0.179;P=0.003、0.011、0.001),HOMA-IR与PCT水平呈明显正相关(r=0.405,P<0.01)。HOMA-IR对脓毒症患者住院期间死亡预后评估的生存曲线显示,当HOMA-IR>2.5时,其住院期间死亡风险明显增加。Logistic回归分析结果显示HOMA-IR、机械通气时间及SOFA评分为脓毒症患者住院期间死亡的独立预测因子(P<0.05)。结论 脓毒症及脓毒症休克患者存在高血糖及胰岛素抵抗,HOMA-IR与疾病严重程度明显相关。HOMA-IR为预测脓毒症患者住院期间死亡的独立危险因素,入院时HOMA-IR>2.5,其住院期间死亡风险明显增加。
关键词:  脓毒症  胰岛素  胰岛素抵抗指数  炎症因子  预后评估
DOI:10.16118/j.1008-0392.2020.01.011
投稿时间:2019-06-21
基金项目:上海市卫生和计划生育委员会项目(2016ZB0204)
The value of insulin resistance index in evaluation of prognosis in patients with sepsis
SONG Yan-li,CHEN Zi-yang,WU Xian-zheng,LI Jia,DAI Guo-xing,ZHANG Hai-xia
(Dept. of Emergency Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China)
Abstract:
Objective To evaluate the prognostic value of homeostasis model assessment insulin resistance index(HOMA-IR) in patients with sepsis. Methods Using a single-center retrospective cohort study, 88 patients with sepsis(44 males and 44 females) admitted to the Emergency ICU at Tongji Hospital Affiliated Tongji University from May 2016 to January 2018 were enrolled. The clinical data of all patients were collected in detail. Fasting serum insulin(FINS), fasting blood glucose(FBG), procalcitonin(PCT), blood lactic acid(Lac), IL-6, IL8 and TNF-α were detected within 24h after admission. The oxygen index(PaO2/FiO2), acute physiology and chronic health scores(APACHE Ⅱ), sequential organ failure scores(SOFA), quick SOFA scores(qSOFA) and HOMA-IR were calculated in all patients. Death during hospitalization was the endpoint of observation. Results Of the 88 patients with sepsis, 68 survived and 20 died. In the death group, the critical scores(APACHE-Ⅱ, SOFA), PCT, IL-6, IL-8, FBG and HOMA-IR were significantly higher than those in the survival group(P<0.05). There was a positive correlation between HOMA-IR and APACHE Ⅱ, SOFA, qSOFA scores(r=0.311, 0.268, 0.179, P=0.003, 0.011, 0.001). There was also a positive correlation between HOMA-IR and PCT level(r=0.405, P<0.01). The survival curve of HOMA-IR in the prognosis of sepsis patients during hospitalization showed that when HOMA-IR>2.5, the risk of death during hospitalization was significantly increased. Logistic regression analysis showed that HOMA-IR, mechanical ventilation time and SOFA score were independent predictors of death in patients with sepsis(P<0.05). Conclusion Patients with sepsis and septic shock have hyperglycemia and insulin resistance. HOMA-IR was significantly correlated with the severity of the disease. HOMA-IR is an independent risk factor for prognosis of sepsis patients. When HOMA-IR>2.5, its risk of death increased significantly during hospitalization.
Key words:  sepsis  insulin  insulin resistance index  inflammation  prognosis

您是第1829484位访问者
版权所有《同济大学学报(医学版)》编辑部
主管单位:教育部 主办单位:同济大学
地  址: 上海四平路1239号 邮编:200092 电话:021-65980705 E-mail: yxxb@tongji.edu.cn
本系统由北京勤云科技发展有限公司设计