急性胰腺炎病人血糖变异度与疾病严重程度及预后的关系

doi:10.16139/j.1007-9610.2025.03.07

摘要/Abstract

摘要：

目的：探讨血糖变异度与急性胰腺炎病人疾病严重程度及预后的关系。方法：选择2019年1月至2019年12月瑞金医院急诊科收治的急性胰腺炎病人242例，根据Marshall评分评估器官衰竭情况，根据亚特兰大评分评估疾病严重程度，比较轻症急性胰腺炎、中度重症急性胰腺炎、重症急性胰腺炎三组入院7 d内的血糖指标，分析不同急性胰腺炎病人的血糖指标与疾病严重程度的关系。以入院是否行穿刺，是否入住重症监护病房（ICU），是否死亡作为终点事件为分类因素，采用One-Way ANOVA、Kruskal-Wallis检验、Mann-Whitney U检验、受试者操作特征（ROC）曲线等分析急性胰腺炎病人的血糖指标与疾病预后的关系。结果：242例中，轻症急性胰腺炎70例(28.9%)，中度重症急性胰腺炎71例(29.3%)，重症急性胰腺炎101例(41.7%)。三组入院7 d内的血糖变异系数比较，差异无统计学意义；重症急性胰腺炎组静脉血糖均值、标准差、最大值、最小值、最大值与最小值之差均高于中度重症急性胰腺炎组，中度重症急性胰腺炎组则高于轻症急性胰腺炎组。有创操作组（IOP）(n=55)血糖均值高于未行有创操作组（NOP）(n=187)。结论：急性胰腺炎病人入院7 d内的血糖水平及波动幅度对病情严重程度和预后的判断有重要意义。

关键词: 静脉血糖均值, 静脉血糖变异度, 急性胰腺炎, 严重程度, 穿刺

Abstract:

Objective To explore the relationship between blood glucose variability, disease severity and prognosis of the patients with acute pancreatitis. Methods Total of 242 patients with acute pancreatitis admitted to the department of emergency from January 2019 to December 2019 were enrolled. The organ failure was evaluated according to Marshall's score, the severity of the disease was evaluated according to Atlanta's score, and the blood glucose indexes of three groups of patients with mild acute pancreatitis, moderate severe acute pancreatitis and severe acute pancreatitis were compared within seven days after admission. The relationship between blood glucose index and disease severity in different patients with acute pancreatitis was analyzed. Taking whether a puncture was performed at admission, whether the patient was admitted to the intensive care unit (ICU), and whether the patient died as endpoint events as classification factors, the relationship between blood glucose indicators and disease prognosis of patients with acute pancreatitis was analyzed using the One-Way ANOVA, Kruskal-Wallis test, Mann-Whitney U test, receiver operating characteristic curve (ROC curve), etc. Results Of the 242 patients, 70 cases (28.9%) were mild acute pancreatitis, 71 cases (29.3%) with moderate severe acute pancreatitis, 101 cases (41.7%) with severe acute pancreatitis. There was no statistically significant difference in the coefficient of variation of blood glucose among the three groups within 7 days of admission. The mean, standard deviation, maximum, minimum value and difference between maximum and minimum value of venous blood glucose in severe acute pancreatitis group were higher than those in moderate severe acute pancreatitis group, while those in moderate severe acute pancreatitis group were higher than those in mild acute pancreatitis group. The mean value of blood glucose of invasive operation group (IOP) (n=55) was higher than that of non-invasive operation (NOP) group(n=187). Conclusions The blood glucose level and fluctuation range of patients with acute pancreatitis within seven days after admission, are of great significance for the judgment of the severity and prognosis of the disease.

Key words: Mean value of venous blood glucose, Variability of venous blood glucose, Acute pancreatitis, Severity, Puncture

中图分类号:

R576

朱诗仪, 陆婷婷, 谢荣理, 谭丹, 费健, 陈尔真, 陈影, 夏怡. 急性胰腺炎病人血糖变异度与疾病严重程度及预后的关系[J]. 外科理论与实践, 2025, 30(03): 223-227.

ZHU Shiyi, LU Tingting, XIE Rongli, TAN Dan, FEI Jian, CHEN Erzhen, CHEN Ying, XIA Yi. The relationship between blood glucose variability, disease severity and prognosis of the patients with acute pancreatitis[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 223-227.

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Item	MAP(n=70)	MSAP(n=71)	SAP(n=101)	Statistical value	P^a) value	P^b) value	P^c)value
Age (year)	44.97±2.02	49.01±2.03	47.16±1.53	F=1.1	0.34	0.24	0.68
Gender	43/27（61.4）	44/27（62.0）	67/34（66.3）	χ²=0.6	0.76	0.95	0.56
Weight (kg)	77.37±2.28	76.65±2.25	74.61±1.61	F=0.5	0.58	0.96	0.68
Diabetes (%)	15/70（21.4）	17/71（23.9）	25/101（24.8）	χ²=0.3	0.88	0.72	0.90
Biliary (%)	30/70(42.9)	30/71(42.3)	49/101(48.5)	χ²=0.9	0.65	0.94	0.42
Mean blood glucose (mmol/L)	8.26±0.35	9.14±0.37	10.95±0.34	H=213.9	<0.000 1	<0.000 1	<0.000 1
GLUSD ( mmol/L)	1.53±0.12	1.70±0.13	2.69±0.38	H=190.9	<0.000 1	<0.000 1	<0.000 1
GLUCV (%)	0.19±0.01	0.18±0.01	0.22±0.02	H=5.0	0.11	0.19	0.07
GLUmax (mmol/L)	10.30±0.44	11.74±0.50	15.78±1.17	H=222.4	<0.000 1	<0.000 1	<0.000 1
GLUmin (mmol/L)	6.55±0.28	7.12±0.30	7.79±0.25	H=182.0	<0.000 1	<0.000 1	<0.000 1
GLUmax-min (mmol/L)	3.75±0.28	4.63±0.36	7.99±1.13	H=182.9	<0.000 1	<0.000 1	<0.000 1
Marshall socre	0.07±0.04	0.86±0.14	5.73±0.28	H=182.3	<0.000 1	<0.000 1	<0.000 1

Item	IOP(n=59)	NOP(n=183)	Z value	P value
Mean blood glucose (mmol/L)	10.27±0.39	9.43±0.26	-2.3	0.023
GLUSD (mmol/L)	2.04±0.19	2.07±0.22	-0.3	0.728
GLUCV (%)	0.19±0.01	0.20±0.01	-0.8	0.423
GLUmax (mmol/L)	13.52±0.71	12.85±0.69	-1.8	0.08
GLUmin (mmol/L)	7.56±0.31	7.13±0.19	-1.5	0.123
GLUmax-min (mmol/L)	5.96±0.58	5.72±0.64	-1.0	0.294
Marshall socre	5.05±0.48	1.90±0.20	-6.3	<0.0001