脓毒症相关性脑病患儿血清胰岛素水平与预后的关系

doi:10.12372/jcp.2022.21e1179

摘要/Abstract

摘要：

目的探讨血清胰岛素水平与脓毒症相关性脑病（SAE）患儿病情严重程度及预后的关系。方法回顾性分析2019年1月—2020年12月入住儿童危重症监护病房（ICU）脓毒症患儿的临床资料。根据ICU患者意识模糊评估法（CAM-ICU）评分或脑电图结果将患儿分为SAE组、非SAE组,将SAE组分为轻中度组和重度组;比较不同组间临床指标。结果共纳入患儿47例,男28例、女19例,年龄24（12~45）月。原发感染源分布情况：呼吸系统21例,消化系统15例,泌尿系统3例,其他8例。非SAE组25例,SAE组22例,其中轻中度SAE组16例、重度SAE组6例。存活31例,死亡16例。入院24 h内发生高胰岛素血症18例（38.3%）。与非SAE组相比,SAE组血清胰岛素水平、S100β蛋白以及降钙素原（PCT）水平较高,高胰岛素血症发生率较高,格拉斯评分较低,差异均有统计学意义（P<0.05）。非SAE组、轻中度SAE组、重度SAE组三组间入院时血清胰岛素水平差异有统计学意义（P<0.05）,以重度SAE组最高。血清胰岛素与S100β水平呈正相关（r_s=0.53,P<0.001）,与格拉斯评分呈负相关（r_s=–0.59,P<0.001）。与存活组相比,死亡组高胰岛素血症发生率及血清胰岛素水平均较高,差异有统计学意义（P<0.05）。结论高胰岛素血症在SAE患儿中发生率较高,动态监测血清胰岛素水平对评估SAE患儿预后有重要临床意义。

关键词: 脓毒症相关性脑病, 高胰岛素血症, 预后, 儿童

Abstract:

Objective To investigate the relationship between serum insulin level and the severity and prognosis of sepsis associated encephalopathy (SAE) in children. Methods The clinical data of children with sepsis admitted to the children's critical care unit from January 2019 to December 2020 were retrospectively analyzed. According to the score of confusion assessment method for the ICU (CAM-ICU) or EEG results, the children were divided into SAE group and non-SAE group, and then SAE group was divided into mild to moderate group and severe group. Clinical indicators were compared among different groups. Results A total of 47 children (28 boys and 19 girls) were included and the median age was 24 (12-45) months. The primary sources of infection were respiratory system (21 cases), digestive system (15 cases), urinary system (3 cases) and other systems (8 cases). There were 25 cases in the non-SAE group and 22 cases in the SAE group, including 16 cases in the mild to moderate SAE group and 6 cases in the severe SAE group. Thirty-one children survived and 16 died. Hyperinsulinemia occurred in 18 children (38.3%) within 24 hours after admission. Compared with non-SAE group, SAE group had higher serum insulin, S100β protein and procalcitonin (PCT) levels, higher incidence of hyperinsulinemia, and lower Glasgow Coma Scale, and the differences were statistically significant (P<0.05). There was significant difference in serum insulin levels at admission among non-SAE group, mild to moderate SAE group and severe SAE group (P<0.05), of which the severe SAE group had the highest level of serum insulin. Serum insulin level was positively correlated with S100β level (r_s=0.53, P<0.001) and negatively correlated with Glasgow Coma Scale (r_s =-0.59, P<0.001). Compared with the survival group, the incidence of hyperinsulinemia and serum insulin level in the death group were significantly higher (P<0.05). Conclusion Hyperinsulinemia has a high incidence in children with SAE. Dynamic monitoring of serum insulin level is of great clinical significance to evaluate the prognosis of children with SAE.

Key words: sepsis associated encephalopathy, hyperinsulinemia, prognosis, child

康霞艳, 张新萍, 范江花, 宋宇雷, 周雄, 曹建设, 贺杰, 肖政辉. 脓毒症相关性脑病患儿血清胰岛素水平与预后的关系[J]. 临床儿科杂志, 2022, 40(3): 218-223.

KANG Xiayan, ZHANG Xinping, FAN Jianghua, SONG Yulei, ZHOU Xiong, CAO Jianshe, HE Jie, XIAO Zhenghui. The relationship between serum insulin level and prognosis in children with sepsis associated encephalopathy[J]. Journal of Clinical Pediatrics, 2022, 40(3): 218-223.

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项目	非SAE组(n=25)	SAE组(n=22)	统计量	P
年龄[M(P₂₅~P₇₅)]/月	21.0(9.0~32.5)	27.5(11.3~54.5)	Z=0.99	0.321
性别(男/女)	14/11	14/8	χ²=0.28	0.595
MAP[n(%)]	69.1±13.6	69.9±10.3	t=0.21	0.080
原发感染源[n(%)]			-	0.502
呼吸系统	13(52.0)	8(36.4)
消化系统	6(24.0)	9(40.9)
泌尿系统	1(4.0)	2(9.1)
其他	5(20.0)	3(13.6)
脓毒症/脓毒症休克（n)	21/4	15/7	χ²=1.63	0.201
PCIS(x±s)/分	74.1±6.5	71.3±5.6	t=1.58	0.382
死亡[n(%)]	4(16.0)	12(54.5)	χ²=7.74	0.005

指标	非SAE组(n=25)	SAE组(n=22)	统计量	P
胰岛素[M(P₂₅~P₇₅)]/mU·L^–1	1.6(1.0~11.4)	10.9(3.3~22.0)	Z=2.60	0.009
S100β(x±s)/μg·L^–1	1.1±0.3	1.8±0.2	t=10.65	<0.001
PCT[M(P₂₅~P₇₅)]/μg·L^–1	3.2(0.8~25.0）	43.9(14.6~92.8)	Z=3.28	0.001
GCS(x±s)/分	13.8±1.6	11.9±3.0	t=2.81	0.007
高胰岛素血症发生率[n(%)]	6(24.0)	12(54.5)	χ²=4.62	0.032

组别	例数	高胰岛素血症[n(%)]	胰岛素水平[M(P₂₅~P₇₅)]/mU·L^–1
存活组	31	7(22.6)	3.0(1.2~10.2)
死亡组	16	10(62.5)	16.7(4.2~43.6)
统计量		χ²=7.28	Z=2.93
P		0.007	0.03