老年糖尿病肺部感染患者空腹血糖变化作为肺部感染致老年多器官功能不全综合征诊断指标的可行性研究

摘要

目的 探讨老年糖尿病肺部感染患者的空腹血糖变化作为肺部感染致老年多器官功能不全综合征(MODSE)诊断指标的可行性.方法 对196例≥65岁的糖尿病肺部感染病例进行回顾性调查,所有病例按肺部感染是否诱发MODSE分为MODSE组(n=89)和非MODSE组(n=107),比较两组患者肺部感染后最高空腹血糖水平的差异.绘制老年糖尿病肺部感染患者最高空腹血糖水平受试者工作特征(ROC)曲线,计算ROC曲线下面积、以及不同空腹血糖水平对MODSE诊断的敏感度和特异度,确定诊断肺部感染致MODSE的最佳空腹血糖阈值.结果 MODSE组最高空腹血糖水平(13.720 ±4.863)mmol/L显著高于非MODSE组(7.439 ± 3.043)mmol/L(t=10.580,P <0.001);老年糖尿病肺部感染患者最高空腹血糖水平ROC曲线下面积为0.900,面积的95%可信区间为0.857~0.943(P <0.001),取空腹血糖8.83 mmol/L时,诊断肺部感染致MODSE的敏感度和特异度均较为理想、分别为86.5%和81.3%.结论 老年糖尿病肺部感染患者的空腹血糖变化对肺部感染致MODSE具有诊断价值、作为肺部感染致MODSE的诊断指标具有可行性.空腹血糖≥8.83 mmol/L可作为一项诊断指标纳入肺部感染致MODSE的诊断.%Objective To explore the feasibility of changes of fasting blood glucose as a diagnostic index of MODSE in elderly diabetic with pulmonary infection.Methods A retrospective study was carried out on 196 diabetic over 65 years old with pulmonary infection.All patients were divide into MODSE group(n=89)and non MODSE group (n=107) according to the onset of MODSE induced by pulmonary infection.The highest fasting blood glucose of two groups were compared.The ROC curve of the highest fasting blood glucose of elderly diabetic with pulmonary infection was drawn,and the area under the ROC curve was calculated.The diagnostic accuracy of different fasting blood glucose were assessed using sensitivity and specificity,and the optimal diagnosis point for MODSE was found.Results The highest fasting blood glucose of MODSE group was significantly higher than the non MODSE group[(13.720 ±4.863) mmol/L VS.(7.439 ±3.043)mmol/L,t=10.580,P<0.01].The area under the ROC curve was 0.900,and 95%CI was 0.857-0.943(P<0.01).When taking the fasting blood glucose 8.83 mmol/L,the sensitivity was 86.5%,the spe-cificity was 81.3%.Conclusion The change of fasting blood glucose in elderly diabetic with pulmonary infection has diagnostic value for MODSE.Fasting blood glucose more than 8.83mmol/L can be used as a diagnostic index in diagno-sis of MODSE in elderly diabetic patients with pulmonary infection.