Objective: To investigate the effects of risk factors such as blood glucose level and its variability on outcome of Tibetan patients at high elevations with acute chronic obstructive pulmonary disease (AECOPD) and type 2 diabetes mellitus (T2 DM). Methods: AECOPD patients with T2 DM were enrolled in this study. All patients enrolled were Tibetan at high elevation. The fingertip blood glucose was monitored regularly daily during hospitalization. The blood glucose level and its fluctuation were assessed by mean fasting blood glucose (FBG) and standard deviation of self-measured blood glucose (SDBG). Acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) assessed the patient's condition, first APACHE-Ⅱ score was given within 24 hours and second 4-7 days later, time-standardized two APACHE-Ⅱ score difference (Δ APACHE) was calculated, analyzed the correlation between FBG, SDBG and Δ APACHE and length of stay. Results : All 5 6 patients, aged (67. 55 ± 3. 28), were enrolled in the study. During hospitalization, Δ APACHE was (2. 06 ± 0. 51), average length of stay (days) was (12. 3 ± 2. 8), FBG (while in hospital) was (8. 04 ± 1. 55) mmol/L, and SDBG was (3. 80 ± 0. 47) mmol/L. Patients were divided into group A (FBG ＜ 7 mmol/L) and group B (FBG＞ 7 mmol/L) according to FBG, or group C (SDBG ＜2 mmol/L), group D (＞ 2 mmol/L). Hospitalization time and Δ APACHE were significantly different between patients in different groups (P ＜ 0. 05). Pearson's correlation analysis show that Δ APACHE is negatively correlated with FBG (r =-0. 540, P ＜ 0. 05), and negatively correlated with SDBG (r =-0. 562, P ＜ 0. 05). Conclusion: The blood glucose level and its variability were negatively correlated with pathogenesis and hospitalization time of AECOPD patients with T2 DM. Improving the quality of strategic hospital glycemic management (maintaining appropriate and stable blood glucose levels) may accelerate the improvement of AECOPD and shorten the hospitalization time, therefore reduce the pain of patients and medical expenses%目的:分析血糖管理质量对2型糖尿病急性加重期(T2DM)合并慢性阻塞性肺疾病(AECOPD)患者病情转归的影响.方法:选择阿坝藏族羌族自治州人民医院住院的T2DM合并AECOPD藏族患者,住院期间每日规律监测患者指尖血糖,以平均空腹血糖水平(FBG)及自测血糖水平的标准差(SDBG)分别评估血糖水平及其波动程度;采用急性生理与慢性健康评分(APACHE-Ⅱ)评估患者病情,计算入院24 h内及第4至第7天的APACHE-Ⅱ评分,并计算时间标准化的两次APACHE-Ⅱ评分差值(ΔAPACHE),分析FBG、SDBG与ΔAPACHE、住院时间的相关性.结果:纳入研究对象56例,年龄(67.55±3.28)岁,ΔAPACHE为(2.06±0.51)分,平均住院时间为(12.3±2.8)d,FBG(住院期间)为(8.04±1.55)mmol/L,住院期间的SDBG为(3.80±0.47)mmol/L.根据FBG将患者分为A组(FBG≤7 mmol/L)和B组(FBG＞ 7 mmol/L);根据SDBG将患者分为C组(SDBG≤2 mmol/L)和D组(＞ 2 mmol/L),A组与B组间,C组与D组间,住院时间、ΔAPACHE比较,差异均有统计学意义(P ＜0.05);Pearson相关性分析提示ΔAPACHE与FBG呈负相关(r=-0.540,P ＜0.05),ΔAPACHE与SDBG呈负相关(r=-0.562,P ＜0.05).结论:纳入患者的血糖水平及其变异性与其病情好转速度和住院时间均为负相关,提高此类患者住院期间血糖管理质量(控制血糖达标,减少血糖波动)可能加快AECOPD病情好转及缩短住院时间,对减少患者痛苦及医疗花费有积极意义.
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