目的 探讨糖化血红蛋白变异指数(HGI)在评价老年2型糖尿病合并髋部骨折术后肺部感染的临床价值.方法 收集2021年1月-2023年4月在同济大学附属上海市第四人民医院行手术治疗的142例老年2型糖尿病合并髋部骨折患者的临床资料,依据术后是否发生肺部感染分为肺部感染组和非肺部感染组,通过电子病历收集2组患者围术期临床资料并进行单因素分析,采用多因素Logistic回归分析术后肺部感染的相关因素.绘制受试者工作特征(Receiver operating characteris-tic,ROC)曲线分析HGI对术后肺部感染的预测价值.结果 与非肺部感染组比较,肺部感染组吸烟史比例高,糖尿病病程和卧床时间长,血清白蛋白水平低,术中出血量多,空腹血糖、糖化血红蛋白(HbA1c)和HGI水平较高,差异有统计学意义(P＜0.05).多因素Logistic回归分析显示,糖尿病病程、卧床时间、空腹血糖、HbA1c和HGI是髋关节术后肺部感染的独立危险因素(P＜0.05).血清白蛋白是保护性因素(P＜0.05).ROC分析显示,HGI预测术后肺部感染的曲线下面积(Area Under the Curv,AUC)为 0.912,明显高于空腹血糖、HbA1c 的 0.654 和 0.817(Z=4.289,P＜0.05),最佳截断值为0.52％,灵敏度和特异度分别为87.21％和85.79％,提示具有良好的诊断效能.以最佳截断值为切入点将患者分为2组,高HGI组中肺部感染发生率(36.11％)显著高于低HGI组(12.86％),差异有统计学意义(P＜0.05).结论 高HGI的老年2型糖尿病合并髋部骨折患者术后发生肺部感染的风险越大,其预测术后肺部感染的价值优于空腹血糖和HbA1c等传统血糖指标,临床应当密切监测HGI的变化,以更好的用于术后肺部感染的风险评估.
A clinical study of hemoglobin glycation index(HGI)in evaluation of postoperative pulmonary infection after hip fracturein elderly patients with type 2 diabetes mellitus
Objective To explore the clinical value of hemoglobin glycation index(HGI)in evaluating lung infection after hip fracture in elderly patients with type 2 diabetes mellitus.Methods The clinical data of 142 elderly patients with type 2 diabetes complicated with hip fracture who underwent surgery in the hos-pital from January 2021 to April 2023 were collected.The patients were divided into pulmonary infection group and non pulmonary infection group according to whether there was pulmonary infection after surger-y.The perioperative clinical data of the 2 groups were collected through electronic medical records and uni-variate analysis was conducted.Multivariate Logistic regression analysis was used to analyze the related factors of postoperative pulmonary infection.Draw Receiver Operating Characteristic(ROC)curves to an-alyze the predictive value of HGI for postoperative pulmonary infection.Results Compared with non pul-monary infection group,the pulmonary infection group had a higher proportion of smoking history,a lon-ger course of diabetes and bed rest time,a lower level of serum albumin,more intraoperative bleeding and higher levels of fasting blood glucose,glycosylated hemoglobin(HbA1c)and HGI(P＜0.05).Multivari-ate Logistic regression analysis showed that the course of diabetes,bed rest time,fasting blood glucose,HbA1c and HGI were independent risk factors for pulmonary infection after hip joint surgery(P＜0.05).Serum albumin was a protective factor(P＜0.05).ROC analysis showed that area under the curve(AUC)of HGI for predicting postoperative pulmonary infection was 0.912,significantly higher than fast-ing blood glucose and HbA1c values of 0.654 and 0.817(Z=4.289,P＜0.05).The optimal cutoff value was 0.52％,and the sensitivity and specificity were 87.21％and 85.79％,respectively,indicating good di-agnostic efficacy.The patients were divided into 2 groups based on the optimal cutoff value.The incidence of pulmonary infection in high HGI group(36.11％)was significantly higher than that in low HGI group(12.86％),and the difference was statistically significant(P＜0.05).Conclusion Elderly patients with type 2 diabetes mellitus combined with hip fracture with high HGI have a higher risk of postoperative lung infection,and its value in predicting postoperative lung infection is better than traditional blood glucose in-dicators such as fasting blood glucose and HbA1c.The changes of HGI should be closely monitored in clinic to better evaluate the risk of postoperative lung infection.
hemoglobin glycation index(HGI)senior citizentype 2 diabeteship fracturepulmonary in-fectionpostoperative complicationspredictive value
万方数据
维普
