应激性高血糖对颅脑损伤患者炎症状态和外周血乳酸、MMP-9水平以及28天死亡率的影响
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摘要
目的探讨应激性高血糖(SHG)对颅脑损伤患者炎症状态和外周血乳酸、基质金属蛋白酶-9(MMP-9)水平以及28天死亡率的影响。方法回顾性分析2015年1月至2018年6月间陕西西安大学第二附属医院收治的236例颅脑损伤患者的临床资料,根据入院后血糖水平分为SHG组(n=154)和非SHG组(n=82)。比较2组一般资料,采用pearson相关分析法分析血糖与患者炎性因子、血乳酸、MMP-9的相关性。比较2组患者院内感染发生率及28天死亡率,使用Cox风险比例模型分析SHG与患者死亡的相关性。结果经pearson相关分析得,颅脑损伤患者血糖与TNF-α、C反应蛋白(CRP)、乳酸水平、MMP-9水平均呈正相关关系(P<0.05);2组颅内感染发生率对比,差异无统计学意义(P>0.05);SHG组肺部感染、颅内感染及院内感染总发生率均高于非SHG组(P<0.05);SHG组较非SHG组28天死亡率低(P<0.05);Cox分析结果显示:高血压病史、格拉斯评分(GSC)评分及SHG对预测患者28天死亡率有统计学意义(P<0.05)。结论颅脑损伤合并SHG患者炎性因子、乳酸、MMP-9水平均更高,SHG可影响颅脑损伤患者病情进展及预后。
Objective To explore the effects of stress hyperglycemia(SHG)on inflammatory states,levels of peripheral blood lactate and matrix metalloproteinase-9(MMP-9)and 28 days mortality rate in patients with craniocerebral injury. Methods The clinical data of 236 patients with craniocerebral injury admitted to the Second Affiliated Hospital of Xi.an Jiaotong University from January 2015 to June 2018 were retrospectively analyzed. According to the blood glucose level after admission,they were divided into SHG group(n=154) and non-SHG group(n=82). The general data of the 2 groups were compared. Pearson correlation analysis was used to analyze the correlation between blood glucose and inflammatory factors,blood lactate and MMP-9. The incidence rate of nosocomial infection and 28 days mortality rate were compared between the 2 groups. The Cox risk ratio model was used to analyze the correlation between SHG and mortality. Results Pearson correlation analysis showed that blood glucose was positively correlated with TNF-α,CRP,lactate and MMP-9 in patients with craniocerebral injury(P<0.05). There was no significant difference in the incidence rate of intracranial infection between the 2 groups(P>0.05). The total incidence rates of pulmonary infection,intracranial infection and nosocomial infection in SHG group were higher than those in non-SHG group(P<0.05). Compared with non-SHG group,the 28 days mortality rate was lower in SHG group(P<0.05). Cox analysis showed that the hypertension history,Giasgow scale(GSC)score and SHG were statistically significant in predicting 28 days mortality rate(P<0.05). Conclusions The levels of inflammatory factors,lactate and MMP-9 are higher in patients with craniocerebral injury and SHG,and SHG could affect the progression and prognosis of patients with craniocerebral injury.
Objective To explore the effects of stress hyperglycemia(SHG)on inflammatory states,levels of peripheral blood lactate and matrix metalloproteinase-9(MMP-9)and 28 days mortality rate in patients with craniocerebral injury. Methods The clinical data of 236 patients with craniocerebral injury admitted to the Second Affiliated Hospital of Xi.an Jiaotong University from January 2015 to June 2018 were retrospectively analyzed. According to the blood glucose level after admission,they were divided into SHG group(n=154) and non-SHG group(n=82). The general data of the 2 groups were compared. Pearson correlation analysis was used to analyze the correlation between blood glucose and inflammatory factors,blood lactate and MMP-9. The incidence rate of nosocomial infection and 28 days mortality rate were compared between the 2 groups. The Cox risk ratio model was used to analyze the correlation between SHG and mortality. Results Pearson correlation analysis showed that blood glucose was positively correlated with TNF-α,CRP,lactate and MMP-9 in patients with craniocerebral injury(P<0.05). There was no significant difference in the incidence rate of intracranial infection between the 2 groups(P>0.05). The total incidence rates of pulmonary infection,intracranial infection and nosocomial infection in SHG group were higher than those in non-SHG group(P<0.05). Compared with non-SHG group,the 28 days mortality rate was lower in SHG group(P<0.05). Cox analysis showed that the hypertension history,Giasgow scale(GSC)score and SHG were statistically significant in predicting 28 days mortality rate(P<0.05). Conclusions The levels of inflammatory factors,lactate and MMP-9 are higher in patients with craniocerebral injury and SHG,and SHG could affect the progression and prognosis of patients with craniocerebral injury.
引文
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[15]何嫦娥,张玉梅,颜汉文,等.Leuven调节的改良方案对重型颅脑损伤患者术后血糖变异的影响[J].中华现代护理杂志,2016,22(27):3921-3924.
[16]余研,吴志峰,秦毅辉,等.银杏叶提取物对大鼠创伤性颅脑损伤后MMP-2和MMP-9的影响[J].中国微侵袭神经外科杂志,2017,22(3):132-135.
[17]李季林,盛罗平,陈仁辉,等.颅脑损伤后血清中MMP-9、S-100B蛋白的表达对颅脑损伤预后及脑水肿的影响[J].中国医师杂志,2016,18(8):1211-1213.
[18]兰展,仇洪,张传东,等.颅脑外伤患者胰岛素抵抗程度与脑损伤、应激反应的相关性研究[J].海南医学院学报,2017,23(7):943-945.
[19]李勃.危急重患者应激性高血糖控制水平与患者预后情况的临床相关性研究[J].解放军药学学报,2016,32(2):177-179.
[2]彭海菁,李杰,陈海琴,等.应激性高血糖的危险因素及护理干预措施[J].蚌埠医学院学报,2016,41(3):399-401.
[3]周涛,李树炎,覃碧云,等.院前干预创伤性应激性高血糖的探讨[J].中国中西医结合急救杂志,2017,24(2):207-209.
[4]董彦,赵路红.应激性高血糖与脑梗死的分型和神经功能预后的相关性[J].贵州医药,2017,41(6):615-616.
[5]赵晓营,任小红.脑卒中后应激性高血糖患者的血糖控制目标[J].解放军护理杂志,2016,33(11):26-28.
[6]张琳,李月成,夏春雷.Aalst胰岛素输注方案对非糖尿病患者颅脑外伤术中血糖及乳酸水平的影响[J].实用药物与临床,2016,19(2):176-179.
[7]李慧,蔡忠林,梁仲珍,等.颅脑外伤急性期血糖、肌酐的变化与疾病转归的研究[J].华南国防医学杂志,2017,31(5):297-299+304.
[8]蒋文庆,卞晓星,陈红春,等.脑外伤患者血清炎症细胞因子与颅内压关系的研究[J].重庆医学,2017,46(8):1060-1062.
[9]吴清松,饶平.强化胰岛素与常规胰岛素对颅脑创伤患者术后应激性高血糖的疗效比较[J].医学综述,2016,22(9):1787-1790.
[10]梁思敏,蔡则成,马赫,等.肿瘤坏死因子-α在骨关节结核中的研究进展[J].宁夏医科大学学报,2018,40(1):115-121.
[11]石宝秋,梁有明.血清粒细胞-巨噬细胞集落刺激因子、肿瘤坏死因子α及C反应蛋白水平与颅脑损伤患者病情严重程度及预后的关系[J].实用心脑肺血管病杂志,2016,24(5):35-38.
[12]柳学,陈纯波,叶珩,等.应激性高血糖对重症脑血管病患者预后的影响[J].中华危重病急救医学,2016,28(4):359-363.
[13]黄怡玲,郑可鲁.应激性高血糖对脓毒血症儿童免疫功能和预后的影响[J].现代医学,2016,44(3):288-291.
[14]苏丽娜,王金环,谷守维,等.动态监测动脉血乳酸水平与急性重症颅脑损伤合并脑心综合征预后的关系[J].内科急危重症杂志,2017,23(1):35-36.
[15]何嫦娥,张玉梅,颜汉文,等.Leuven调节的改良方案对重型颅脑损伤患者术后血糖变异的影响[J].中华现代护理杂志,2016,22(27):3921-3924.
[16]余研,吴志峰,秦毅辉,等.银杏叶提取物对大鼠创伤性颅脑损伤后MMP-2和MMP-9的影响[J].中国微侵袭神经外科杂志,2017,22(3):132-135.
[17]李季林,盛罗平,陈仁辉,等.颅脑损伤后血清中MMP-9、S-100B蛋白的表达对颅脑损伤预后及脑水肿的影响[J].中国医师杂志,2016,18(8):1211-1213.
[18]兰展,仇洪,张传东,等.颅脑外伤患者胰岛素抵抗程度与脑损伤、应激反应的相关性研究[J].海南医学院学报,2017,23(7):943-945.
[19]李勃.危急重患者应激性高血糖控制水平与患者预后情况的临床相关性研究[J].解放军药学学报,2016,32(2):177-179.
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