【摘要】 目的 分析ICU住院2型糖尿病伴感染性休克患者尿酸与短期预后的关系。方法 回顾性收集2015-01～2018-01收住安徽省立医院ICU且存在感染性休克的2型糖尿病患者共126例。根据患者28 d生存情况将其分为死亡组和存活组,记录所有患者性别、年龄、糖尿病病程,并于次日抽取空腹静脉血检测PCT、乳酸(Lac)、尿酸、糖化血红蛋白(HbA1c)、空腹血糖(FPG),计算当日APACHEⅡ评分进行回顾性分析。入科后每日连续监测血尿酸水平,并记录尿酸最低值以及计算相对应的APACHEⅡ评分。结果 ①126例患者APACHEⅡ评分为(20. 56±4. 79)分,总体病死率为26. 2%。与存活组比较,死亡组基线尿酸(UA)低[(363. 08±169.79)μmol/L vs.(268.06±111.84)μmol/L,P=0.001]、Lac及APACHEⅡ评分较高[Lac:(2.95±1.71)mmol/L vs.(5. 03±3.06)mmol/L,P=0. 028; APACHEⅡ评分:(18. 12±5. 06)分vs.(23.91±7.79)分,P=0.040]。血糖控制及病程对短期预后无显著影响(均P>0.05);②将单因素分析中有差异的指标纳入Logistic回归模型,提示尿酸以及APACHEⅡ评分是2型糖尿病伴感染性休克患者死亡的相对独立危险因素(均P<0. 05);③无论是基线尿酸还是尿酸最低值均与当日的APACHEⅡ呈负相关(均P<0.05);与存活组比较,死亡组尿酸最低值更低[(278. 50±63.09)μmol/L vs.(150. 16±55. 36)μmol/L, P=0. 000],其当日的APACHEⅡ评分更高[(19.89±6.82)vs.(27.83±10.25),P=0.001;④尿酸最低值的受试者工作特征曲线下面积较基线尿酸值大(0.666±0.055 vs.0.84±0.041,P<0.0001)。根据ROC曲线约登指数,尿酸最低值相应的截点值为226. 5μmol/L,其对死亡预测敏感度为78%,特异度为86%。结论 低尿酸血症是2型糖尿病伴感染性休克患者28 d死亡的相对独立危险因素,尿酸最低值可用于评估疾病进展并且其<226.5 mmol/L可作为预后不良的诊断切点。更多还原

【Abstract】 Objective To analysis the correlation between serum uric acid and short-term prognosis on ICU patients with type 2 diabetes mellitus( T2DM) and septic-shock. Methods A prospective cohort study of 126 T2DM patients with septic shock in ICU was divided into 2 groups. The,death group(n = 33) and living group( n = 93). General data of patients sex, age, PCT, Lac, Hba1c,FPG, duration of diabetes, UA, APACHE Ⅱ scores on admission and minimum concentration of uric acid was measured and recorded. Results There were no significant differences of HbA1c, FPG and duration of diabetes on admission between survival group and death group, but Lac and APACHE Ⅱscores of the death group on admission were significantly higher thLan the survival group [ Lac:(2. 95 ±1.71) mmol/L vs.(5.03±3.06) mmol/L,P= 0.028; APACHE Ⅱ :(18. 12±5.06) vs.(23.91 ±7. 79),P =0.040], UA of the death group were significantly lower than those of the survival group[(363.08 ± 169.79) μmol/L vs.(268. 06 ± 111. 84) μmol/L,P =0. 001 ]. The related factors were analyzed by Logistic Regression Model, showing that UA, APACHE II scores are statistically different between two groups(P <0. 05). UA levels in patients on admission and minimum were negative correlated with APACHE Ⅱ score(R were -0. 379 and -0. 634, P < 0. 05). The area under the receiver operating characteristic curve was 0. 666, 0. 840 respectively, according to the level of the UA at baseline and minimum concentration. The cut off of minimum UA was 226.5 μmol/L, resulting in a sensitivity of 78% and a specificity of 86%. Conclusion Study had shown that the lower concentration of UA was associated with unfavorable prognosis in ICU patients with T2DM and septic shock. The minimum concentration of UA might be the indicator for predicting the condition of patients and UA equal to 226.5 μmol/L can be used as a cutoff point.更多还原