老年非糖尿病肺部感染患者空腹血糖变化对多器官功能不全综合征的诊断价值

摘要

目的 探讨老年非糖尿病肺部感染患者血糖变化对老年多器官功能不全综合征(MODSE)的诊断价值.方法回顾性分析2005年1月至2014年12月解放军白求恩国际和平医院≥65岁的非糖尿病肺部感染患者429例,根据肺部感染是否诱发MODSE分为MODSE组(n=95)和非MODSE组(n=334),比较两组患者肺部感染后最高空腹血糖值的差异.利用SPSS 17.0软件对数据进行统计分析.计量资料用均数±标准差(±s)表示,两组比较采用t检验.计数资料用百分率表示,组间比较用x2检验.受试者工作特征(ROC)曲线确定诊断肺部感染致MODSE的最佳空腹血糖值.结果 MODSE组患者最高空腹血糖值[(8.656±2.664)mmol/L]显著高于非MODSE组患者[(5.679±1.332)mmol/L],差异具有统计学意义(t=10.523,P<0.05).血糖值为6.875 mmol/L时诊断肺部感染致MODSE的灵敏度为83.2%, 特异度为90.1%,ROC曲线下面积为0.880,95%可信区间为0.835~0.926(P<0.001),诊断价值较高.结论 老年非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,空腹血糖≥6.875 mmol/L可作为一项指标纳入肺部感染致MODSE的诊断.%Objective To explore the changes of fasting blood glucose in elderly non-diabetic patients with pulmonary infection, and investigate its value in the diagnosis of multiple organ dysfunction syndrome in the elderly (MODSE).Methods A retrospective study was carried out on 429 non-diabetic patients (over 65 years old) with pulmonary infection in our hospital from January 2005 to December 2014.According to whether pulmonary infection induced the onset of MODSE, the patients were divided into MODSE group (n=95) and non-MODSE group (n=334).The highest level of fasting blood glucose was compared between the two groups.SPSS 17.0 software was used to analyze the data.The quantitative data were expressed as mean±standard deviation (±s), and the results were compared with Student's t test.Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test.The receiver operating characteristic (ROC) curve was used to determine the cut-off value of blood glucose levels for the MODSE diagnosis.Results The highest fasting blood glucose level in the MODSE group was significantly higher than that in the non-MODSE group [(8.656±2.664) vs (5.679±1.332)mmol/L, t=10.523, P<0.001].When the cut-off value of fasting blood glucose was 6.875 mmol/L, the sensitivity was 83.2%, the specificity was 90.1%, the area under the ROC curve was 0.880, and 95%CI was 0.835-0.926 (P<0.001), with high diagnostic value.Conclusion The changes of fasting blood glucose are of value in the diagnosis of MODSE induced by pulmonary infection for the elderly non-diabetic patients.Fasting blood glucose ≥6.875 mmol/L can be used as an index in diagnosis of MODSE induced by pulmonary infection.