| Part AAims To investigate glycometabolism of coronary care unit(CCU)patients with acute coronary syndrome(ACS)and analyze the occurrence rate of abnormal glycometabolism;to explore the relationships among immediate blood glucose,fructose amine,glycated hemoglobin(HbAlc)and global registry of acute coronary Events(GRACE)risk score;to evaluate characteristics of the ACS patients‘glucose fluctuation by using continuous glucose monitoring system(CGMS)and explore relationships of low-,moderate-and high-GRACE risk scores with glucose fluctuation and the relationship of GRACE risk scores of ACS patients on different glycometabolism condition with glucose fluctuation.Methods 76 ACS patients admitted to CCU of Nanjing No.1 Hospital from July 2015to January 2016 were selected as subjects of the present study.General information such as age,sex,diabetic history and vital signs were collected,and their immediate blood glucose,fructose amine and HbAlc were measured at the beginning of their admission.The subjects were evaluated by the GRACE risk scoring system and assigned to the following groups based on their scores:(1)low-risk group(14subjects),(2)moderate-risk group(25 subjects)and(3)high-risk group(37 subjects).All subjects received a 72-hour CGMS and their 24-hour mean blood glucose levels(24hMBG),standard deviation of blood glucose(SDBG),mean amplitude of glycemic excursion(MAGE),area under the curve(AUC)and percentage time(PT)were calculated.The subjects were classified as abnormal glycometabolism group(24previously diagnosed diabetic patients,8 newly diagnosed diabetic patients,12impaired glucose tolerance patients,and 8 stress hyperglycemia patients)and normal glycometabolism group(24 patients)according to American Diabetes Association(ADA)diagnostic criteria.The occurrence rate of abnormal glycometabolism of the CCU ACS patients was analyzed.The relationships of immediate blood glucose,fructose amine,HbAlc,24h-MBG,SDBG,MAGE,AUC and PT with GRACE risk scores were explored.The relationships of immediate blood glucose,fructose amine,HbAlc,24h-MBG,SDBG,MAGE,AUC and PT of abnormal glycometabolism ACS patients and normal glycometabolism ACS patients with GRACE risk scores were explored respectively.Results(1)The incidence of abnormal glycometabolism with ACS patients was up to68.42%.(2)There were 14 patients in low-risk group,25 patients in moderate-risk group and 37 patients in high-risk group.Their immediate blood glucose were(7.89±4.36)mmol/L,(10.66±4.48)mmol/L and(11.51±6.41)mmol/L respectively,and there was statistically significance between high-risk group and low-risk group(P<0.05).The HbAlc of the three groups were respectively(6.29±1.69)%,(7.04±2.05)%and(6.78±2.09)%,and there was no statistically significance among them.(3)As for abnormal glycometabolism subjects,the immediate blood glucose of the low-,moderate-and high-risk groups were respectively(8.85±5.67)mmol/L,(11.8±4.58)mmol/L,(13.59±6.88)mmol/L,and there was statistically significance between high-risk group and low-risk group(P<0.05).Among normal glycometabolism subjects,the immediate blood glucose of the low-,moderate-and high-risk groups were respectively(6.6±0.97)mmol/L,(7.03±0.53)mmol/L and(7.19±1.09)mmol/L,and there was no statistically inter-group significance(P>0.05).No statistical significance was found among the low-,moderate-and high-risk groups for neither abnormal glycometabolism subjects nor normal glycometabolism subjects in HbAlc and fructose amine(P>0.05).(4)The 24h-MBGs of the low-,moderate-and high-risk groups were(6.59±1.62)mmol/L,(8.20±2.60)mmol/L and(8.50±2.87)mmol/L,and the 24h-MBGs of the moderate-and high-risk groups were obviously higher than that of the low-risk group,the differences of which were of statistical significances(P<0.05);the MAGEs of the low-,moderate-and high-risk groups were respectively(2.60±1.34)mmol/L,(4.18±2.52)mmol/L and(4.51±3.98)mmol/L,and the MAGEs of both the moderate-and high-risk groups were obviously higher than that of the low-risk group,the differences of which were of statistical significances(P<0.05);(5)Using 3.9 mmol/L of MAGE as a dividing line,we divided the subjects into two groups:the MAGE?3.9mmol/L group and the MAGE<3.9mmol/L group,and did a chi-square test with GRARE risk scores(low-,moderate-and high GRACE risk scores),the result of which wasc~2=6.544(P=0.038).(6)Among abnormal glycometabolism group,the 24h-MBGs of the low-,moderate-and high-risk groups were(6.88±2.09)mmol/L,(8.99±2.50)mmol/L and(9.60±2.88)mmol/L respectively,those of the moderate-and high-risk groups were higher than that of the low-risk group,the differences of which being of statistical significances(P<0.05);the MAGEs of the low-,moderate-and high-risk groups were(3.08±0.78)mmol/L,(4.94±2.31)mmol/L and(5.64±4.30)mmol/L respectively,those of the moderate-and high-risk groups were higher than that of the low-risk group,the differences of which being of statistical significances(P<0.05).Among normal glycometabolism group however,there was no statistical significance in neither the 24h-MBGs nor the MAGEs of the low-,moderate-and high-risk groups(P(29)0.05).Conclusions(1)The occurrence rate of abnormal glycometabolism of the ACS patients was as high as 68.42%.More efforts should be done on abnormal glyco-metabolism screening for ACS patients.(2)Among all of the ACS patients,the immediate blood glucose of high-risk group was higher than that of the low-risk group and sub-group analysis found that the high-risk group of abnormal glyco-metabolism patients had higher immediate blood glucose while no similar result was found among normal glycometabolism patients,which indicated that more efforts should be done on screening of immediate blood glucose for the high-GRACE risk scored abnormal glycometabolism patients.(3)The glucose fluctuations of the moderate-and high-GRACE risk scored groups were significantly higher than that of the low-GRACE risk scored group,and sub-group analysis found that the glucose fluctuations of the moderate-and high-GRACE risk scored groups were higher among abnormal glycometabolism patients,while no similar results were found among normal glycometabolism patients,which indicated that more attention should be paid to glucose fluctuations of the moderate-and high-GRACE risk scored ACS patients who were with abnormal glycometabolism,while there may not be such need to do CGMS to the low-GRACE risk scored ACS patients with abnormal glycometabolism or to the ACS patients with normal glycometabolism.Part BAims To investigate intensive care unit(ICU)patients‘ glycometabolism and analyze the occurrence rate of abnormal glycometabolism;to explore the relationships of immediate blood glucose,Hb Alc and fructose amine with prognosis on the 28 th day of ICU admission;to evaluate glucose fluctuation of ICU patients by CGMS and explore its relationship with patients‘ prognosis.Methods 95 patients admitted into ICU of Nanjing No.1 Hospital from July 2015 to January 2016 were selected as subjects of the present study with their relative information such as medical history,vital signs,indexes of glycometabolism etc.being collected and their occurrence rate of abnormal glycometabolism were analyzed.Based on their prognosis on the 28 th day of ICU admission,the subjects were assigned into two groups: the survivor group and the non-survivor group.Indexes of glyco-metabolism were compared between the two groups.The subjects were further stratified into various subgroups according to their glasgow coma scale(GCS)scoring,primary disease,glycometabolism type and Hb A1 c level,and indexes of glyco-metabolism of each subgroups were compared between the survivor group and the non-survivor group.CGMS were applied to 75 critical ill patients,their 24h-MBG,SDMG,MAGE and PT were calculated,and blood glucose spectrum of various glycometablism groups were analyzed.Indexes of glucose fluctuation were compared between the survivor group and the non-survivor group.Differences in indexes such as 24h-MBG,SDBG,MAGE etc.between the survivor group and the non-survivor group of the above all subgroups stratified according to glycometabolism type,GCS scoring,and primary disease were compared and discussed.Results(1)68 of the 95 ICU patients had abnormal glycometabolism(71.6%);the occurrence rate of the ?65(years old)group was 56.8% and that of the >65(years old)group was 81%,and there was statistically significant difference between the two groups(P<0.05).(2)Based on their prognosis on the 28 th day of ICU admission,80 patients were assigned into the survivor group(84.2%)and 15 to the non-survivor group(15.8%).The immediate blood glucose of the survivor group and the non-survivor group were respectively(9.37± 3.93)mmol/L and(11.12±5.06)mmol/L.The immediate blood glucose of the non-survivor group tended to be higher than that of the survivor group.There was,however,not statistical significance(P>0.05).The fructose amine and Hb Alc of the survivor group were similar to those of the non-survivor group.(3)Comparisons in glycometabolism among different sub-groups:(1)The subjects were assigned to three groups according to their immediate blood glucose levels: the ?10mmol/L group,the 10-13.9mmol/L group and the >13.9 mmol/L group.The mortality rates of the three groups till the 28 th day of ICU admission were respectively 10.34%,20.83% and 30.77%.The higher the immediate blood glucose levels were at the time of admission,the higher the mortality rates the patients had till the 28 th day of ICU admission,the tendency being not of statistical significance though(P=0.139).(2)Among the patients whose Hb A1 c were less than 6.5%,the immediate blood glucose levels of the survivor group and the non-survivor group were respectively(7.89±2.54)mmol/L and(9.87±4.05)mmol/L,and there was statistically significant inter-group difference(P<0.05).The fructose amine and Hb Alc of the two groups were similar.Among the patients whose Hb A1 c were ?6.5%,there was no statistically significant difference between the survivor group and the non-survivor group in either immediate blood glucose,fructose amine and Hb Alc levels(P>0.05).(3)No statistically significant difference in immediate blood glucose,fructose amine and Hb Alc were found between the survivor group and the non-survivor group either among abnormal blood glycometabolism patients or among normal blood glycometabolism patients.The stress hyperglycemia group: the immediate blood glucose of the survivor group and the non-survivor group were respectively(12.75±1.18)mmol/L and(16.65±1.77)mmol/L,and there was statistically significant difference between two groups(P<0.05).No statistically significant inter-group difference was found in fructose amine and Hb Alc levels(P>0.05).(4)Among the patients whose GCS were?8,the immediate blood glucose of the survivor group and the non-survivor group were respectively(9.08±3.46)mmol/L and(11.80±5.26)mmol/L,and there was statistically significant inter-group difference(P<0.05);among the patients whose GCS were >8,no statistically significant difference was found between two groups.There were no statistically significant differences between the survivor group and the non-survivor group of two subgroups in either fructose amine or Hb Alc levels(P>0.05).(5)Among the cerebrovascular accident patients,the immediate blood glucose levels of the survivor group and the non-survivor group were respectively(8.43±3.24)mmol/L and(12.97±5.66)mmol/L,and there was statistically significant difference between the two groups;no statistically significant difference was found between the two groups in fructose amine or Hb Alc levels(P>0.05).Among the non-cerebrovascular accident patients,however,no statistically significant difference was found between the two groups in either immediate blood glucose,fructose amine or Hb Alc levels(P>0.05).(4)Of all the 95 subjects,75 patients received CGMS.The data showed that the 24h-MBG and MAGE of the non-survivor group tended to be higher than the survivor group,but no statistically significant difference was found(P>0.05).Comparison on glucose fluctuation of various sub-groups:(1)According to levels of 24h-MBG,the subjects were divided into three subgroups: the 24h-MBG <6.0 mmol/L group,the 6.0?24h-MBG?10.0mmol/L group and the 24h-MBG>10.0 mmol/L group;the mortality rates of the three sub-groups were respectively 0%,8.9% and 19.2%.According to MAGE,the subjects were divided into two sub-groups: the MAGE< 3.9mmol/L group and the MAGE?3.9mmol/L group;the mortality rates ofthe two sub-groups were respectively 7.0% and 18.8%.Data showed that higher 24h-MBG groups and higher MAGE groups had higher mortality rates,but no statistically significant inter-group difference was found(P>0.05).(2)According to glyco-metabolism types,the subjects were divided into two groups: abnormal glycometabolism group and normal glycometabolism group.Among abnormal glycometabolism group,the 24h-MBG,MAGE and SDBG of the non-survivor group tended to be higher than those of the survivor group,but no statistically significant difference was found(P>0.05).Among normal glycometabolism group,the 24 hMBG,MAGE and SDBG of the non-survivor group were similar to those of the survivor group.Conclusions Abnormal glycometabolism was popular among ICU patients,and it was especially the case for those older than 65 years old who had higher occurrence rate of abnormal glycometabolism.It was therefore necessary to pay more attention to the critical ill patients,especially to the aged critical ill patients.The immediate blood glucose was correlated to patients‘ prognosis.Sub-group analysis indicated that especially for those Hb A1c< 6.5%,stress hyperglycemia,or GCS scores ?8,or cerebrovascular accident patients,the immediate blood glucose level were closely correlated to the 28 th day prognosis;while no correlations between fructose amine and the 28 th day prognosis or between Hb Alc level and the 28 th day prognosis were found,which indicated that immediate blood glucose was more important to the prognosis of the critical ill patients than fructose amine and Hb Alc.Analysis of continuous glucose monitoring spectrum showed that the 24h-MBG and MAGE of the non-survivor group tended to be higher than those of the survivor group,and the mortality rate of the high 24h-MBG group and of the high MAGE group were higher,which indicated that glucose level and glucose fluctuation were correlated to the patients‘ prognosis. |
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