摘要
目的:探讨应激性高血糖在脓毒症患者病情评估和预后预测中的作用。方法:44例脓毒症患者根据入院24 h内血糖监测结果和既往病史分为3组:应激性高血糖组(SH,n=15)、糖尿病组(DM,n=10)和正常血糖组(NG,n=19)。确诊24 h内流式细胞仪检测CD4+/CD8+比值、Th1/Th2比值和。CD14+单核细胞人类白细胞抗原-DR(HLA-DR)表达率,记录感染相关器官衰竭评分系统(SOFA)评分和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ),并随访28d临床结局。分析应激性高血糖与免疫功能变化及28 d死亡率的关系。结果:应激性高血糖组死亡率高于糖尿病组(53.3%vs10.0%)和正常血糖组(53.3%vs21.1%);应激性高血糖组SOFA评分和APACHEⅡ评分均高于其余两组;HLA-DR活化水平明显低于糖尿病组(P<0.05)和正常血糖组(P<0.05);CD4+/CD8+比值亦低于其余两组;死亡组SOFA评分和APACHEⅡ评分明显高于存活组,HLA-DR%(65.33±12.34vs91.54±9.89)和Th1/Th2比值(5.54±2.81vs8.97±4.93)显著低于存活组。结论:脓毒症患者应激性高血糖与免疫功能变化有一定相关性,可以作为病情评估和预后预测的指标之一。
AIM： To investigate the role of stress hyperglycemia on condition assessment and predicting prognosis in patients with sepsis. METHODS ： The study included 44 patients with sepsis, divided into three groups according to their blood glucose profile within 24 h after admission ： patients with stress hyperglycemia （ group SH, n = 15 ）, diabetes mellitus type 2 （group DM, n = 10）, and normal glucose levels （group NG, n = 19）. CD4^＋/CD8^＋ ratio, Th1/Th2 ratio and HLA - DR% of the patients were measured within 24 h after admission by flow cytometry as assessment of their immune function. The sepsis -related organ failure assessment （SOFA） scores and acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） scores of patients were recorded at the same time to analyze whether stress hyperglycemia affects the immune function and the 28 d mortality in patients with sepsis. RESULTS： A higher mortality rate of septic patients with stress hyperglycemia was observed compared to diabetic patients （53.3% vs 10. 0% ） and group NG （53.3% vs 21.1% ）. SOFA score and APACHE Ⅱ score were higher in group SH than those in group DM and group NG while lower levels of human leucocyte antigen DR （HLA - DR） expression and CD4 ^＋/CD8^＋ ratio was found in group SH than those in group DM and group NG. No difference in the levels of Th1/Th2 among the three groups was observed. Non - survivors had higher levels of SOFA score, APACHE Ⅱ score, Th1/Th2 ratio and HLA - DR%. No difference was detected for CD4^＋/ CD8 ^＋ ratio, mean glucose values and age. CONCLUSION： Stress hyperglycemia is associated with decreased immune function and an adverse clinical outcome in patients with sepsis.
出处
《中国病理生理杂志》
CAS
CSCD
北大核心
2009年第4期755-758,共4页
Chinese Journal of Pathophysiology
基金
广东省科技计划资助项目(No.2005B30701011)
广东省科技计划资助项目(No.2008B080703039)
关键词
应激性高血糖症
脓毒症
糖尿病
免疫功能
预后
Stress hyperglycemia
Sepsis
Diabetes mellitus
Immune function
Prognosis
