脓毒症患者中糖尿病对病原菌耐药性、疾病严重程度以及临床结局的影响：一项回顾性队列研究

doi:10.3969/j.issn.1009-976X.2024.04.005

摘要/Abstract

摘要： 目的本研究旨在通过回顾性分析脓毒症患者的临床资料,深入探讨糖尿病（DM）对病原菌耐药性的影响,以及与疾病严重程度的相关性。方法回顾性收集2020年1月至2021年12月诊断为脓毒症的成年患者。收集患者临床数据,实验室数据,感染指标数据,临床诊疗数据等。根据患者是否伴有2型糖尿病,将患者分为DM组和非DM组两组,比较两组的临床数据、实验室数据、感染指标数据和临床诊疗数据。此外,进行多因素分析,探究DM组对比非DM组影响临床死亡结局的独立危险因素。结果共纳入189例脓毒症患者,平均年龄70.9±9.7岁。与非DM组的患者相比,DM组患者的入院时葡萄糖（224.6±64.3 vs. 84.9±7.1,P<0.001）、糖化血红蛋白（8.2±2.0 vs. 6.7±0.9,P<0.001）水平显著升高,白蛋白（40.2±3.7 vs. 41.6±2.7,P=0.006）水平显著降低。并且,DM组患者的药敏结果耐药较非DM组比例明显更高（86.7% vs. 49.5%,P<0.001）。此外,与非DM组的患者相比,DM组患者的SOFA评分（16.3±5.4 vs. 11.8±3.9,P<0.001）、APACHEⅡ评分（38.4±8.9 vs. 16.8±12.9,P<0.001）更高。DM组临床结局死亡的患者占比更高（41.8% vs. 14.3%,P<0.001）。最后发现只有入院时葡萄糖（OR=9.711,95%CI：2.889~32.639,P<0.001）与临床结局（死亡）独立相关。结论脓毒症合并糖尿病患者细菌耐药比例更高;疾病严重程度更重,临床结局（死亡）比例更高。并且入院时高葡萄糖是患者死亡的独立危险因素。

关键词: 脓毒症, 糖尿病, 病原菌耐药性, 危险因素

Abstract: Objective The aim of this study was to investigate in depth the effect of diabetes mellitus （DM）on pathogenic bacterial resistance and its correlation with the severity of the disease by retrospectively analyzing the clinical data of patients with sepsis. Methods Adult patients diagnosed with sepsis from January 2020 to December 2021 were retrospectively collected. Patients' clinical data, laboratory data, infection indicator data, and clinical diagnosis and treatment data were collected. According to whether the patients were accompanied by type 2 diabetes mellitus or not, the patients were categorized into two groups, DM group and non-DM group, and the clinical data, laboratory data, infection index data, and clinical diagnosis and treatment data of the two groups were compared. In addition, multifactorial analysis was performed to explore the independent risk factors affecting clinical mortality outcomes in the DM group compared with the non-DM group. Results A total of 189 patients with sepsis were included, with a mean age of 70.9±9.7 years. Compared with patients in the non-DM group, patients in the DM group had significantly higher levels of glucose （224.6±64.3 vs. 84.9±7.1, P<0.001） and glycosylated hemoglobin （8.2±2.0 vs. 6.7±0.9, P<0.001） and significantly lower levels of albumin （40.2±3.7 vs. 41.6±2.7, P=0.006） on admission. were significantly lower. Moreover, a significantly higher proportion of patients in the DM group had drug-resistant drug sensitization results compared to the non-DM group （86.7% vs. 49.5%, P<0.001）. In addition, patients in the DM group had higher SOFA scores （16.3±5.4 vs. 11.8±3.9, P<0.001）, APACHE Ⅱ scores （38.4±8.9 vs. 16.8±12.9, P<0.001） compared to those in the non-DM group.A higher percentage of patients died of clinical outcomes in the DM group （41.8% vs. 14.3%, P<0.001）. Finally, only glucose on admission （OR=9.711, 95% CI：2.889~32.639, P<0.001） was found to be independently associated with clinical outcome （death）. Conclusion Patients with sepsis combined with diabetes had a higher proportion of bacterial resistance; more severe disease severity and a higher proportion of clinical outcome （death）. And high glucose on admission was an independent risk factor for patient death.

Key words: sepsis, diabetes mellitus, pathogenic bacterial resistance, risk factors

中图分类号:

R631

麦岚, 秦伟强, 许昌琴, 吴娜. 脓毒症患者中糖尿病对病原菌耐药性、疾病严重程度以及临床结局的影响：一项回顾性队列研究[J]. 岭南现代临床外科, 2024, 24(04): 231-237.

MAI Lan, QIN Wei-qiang, XU Chang-qin, WU Na. Impact of diabetes mellitus on pathogenic bacteria resistance, disease severity, and clinical outcomes among septic patients： a retrospective cohort study[J]. Lingnan Modern Clinics In Surgery, 2024, 24(04): 231-237.

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