摘要
目的研究糖尿病对脓毒症患者病原菌分布及预后的影响。方法回顾性分析2013年6月至2015年6月天津医科大学总医院急诊医学科住院治疗的282例脓毒症患者的临床资料,根据其是否患有糖尿病分为糖尿病组和非糖尿病组,记录两组患者空腹血糖(Glu)、糖化血红蛋白(Hb A1c)、C反应蛋白(CRP)、降钙素原(PCT)等各项实验室指标以及是否发生多器官功能障碍综合征(MODS)及入院后第28天预后情况,计算患者急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)。采用SPSS 17.0软件处理数据,比较两组数据有无统计学差异,并进行相关分析及Logistic回归分析。结果 282例脓毒症患者的培养标本中,共分离出细菌348株,糖尿病组大肠埃希菌比例最高,占总数的25.9%,主要感染部位为泌尿系统,占46.4%。与非糖尿病组相比,糖尿病组合并真菌感染患者比例(70.5%)及病死率(24.7%)均显著升高。糖尿病组CRP、PCT、APACHEⅡ评分均高于非糖尿病患者,且易合并MODS(P<0.05)。Spearman相关分析显示,糖尿病组CRP、PCT、APACHEⅡ评分以及MODS与预后呈正相关。Logistic回归分析显示,APACHEⅡ评分是患者死亡的独立危险因素(P<0.05)。结论糖尿病可影响脓毒症患者病原菌种类及分布。脓毒症糖尿病患者APACHEⅡ评分是预测患者预后的独立危险因素。
Objective To study the effect of diabetes on the spectrum of pathogenic bacteria and prognosis of patients with sepsis. Methods 282 septic patients admitted in the department of emergency medicine of Tianjin Medical University from June 2013 to June 2015 were divided into the diabetes group and the non-diabetes group. A variety of clinical and laboratory variables were recorded including Glu, Hb A1 c, CRP, PCT, MODS and APACHEⅡ to perform correlation and Logistic regression analysis by SPSS 17.0 software. Results Among the 282 cases of sepsis, 348 strains of bacteria were isolated, and the proportion of Escherichia coli in the diabetes group was the highest（25.9%）. Urinary system was the most commonly infected site（46.4%）. Compared with the non-diabetes group, the diabetes group was easier to merge fungal infection（70.5%）, and had a higher mortality（24.7%）. Spearman correlation analysis showed that the CRP, PCT, MODS and APACHEⅡ score in diabetes group were significantly higher（P〈0.05）. Logistic regression analysis showed that the APACHEⅡ score was a significantly independent factor for death prediction in patients with sepsis（P〈0.05）. Conclusions Diabetes affected the types and distribution of pathogenic bacteria in patients with sepsis. APACHEⅡ score in patients with diabetes was an independent risk factor for predicting the prognosis of patients.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第9期79-82,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
脓毒症
糖尿病
感染
预后
Sepsis
Diabetes mellitus
Infection
Prognosis
