血糖、降钙素水平在危重病神经肌病诊断与预后中的价值与应用

曾志良??唐修明??李穗生??高有安??黎展鸿??刘越存??李红兰

[摘要] 目的 探讨血糖、降钙素水平在危重病神经肌病诊断与预后中的价值与应用。 方法 回顾性分析我院神经内科收治的危重病神经肌病患者56例，按照患者治疗结局分为存活组及死亡组。其中存活组43例，死亡组13例，同时根据ROC曲线截点分组，其中联合组30例，非联合组26例，其中联合组死亡11例，非联合组死亡2例。 结果 与死亡组比较，存活组降钙素原、血糖及APACHEⅡ评分较低（P<0.05）。ROC曲线中，AUC为0.7～0.9、面积值为1.0～0.5时证实准确度较高，当AUC=0.5时为无诊断价值。 结论 联合血清降钙素原和血糖可以对危重病神经肌病患者进行预后评估，有利于早期干预，降低病死率。

[关键词] 血糖；降钙素；危重病神经肌病；诊断价值

[中图分类号] R746 [文献标识码] A [文章编号] 2095-0616（2017）12-178-04

Value and application of blood glucose and calcitonin levels in the diagnosis and prognosis of critical neurological myopathy

ZENG Zhiliang TANG Xiuming LI Suisheng GAO Youan LI Zhanhong

LIU Yuecun LI Honglan

Internal Medicine-Neurology， Dongguan Fifth People's Hospital， Guangdong， Dongguan 523905， China

[Abstract] Objective To explore the value and application of blood glucose and calcitonin levels in the diagnosis and prognosis of critical neurological myopathy. Methods 56 cases of critically ill patients with myopathy cured in internal Medicine-Neurology of our hospital were retrospectively analyzed. They were divided into survival group and death group according to the treatment outcome， with 43 cases in survival group and 43 cases in death group. At the same time， according to the ROC curve， they were divided into two groups， including 30 cases in the combined group and 26 cases in the non union group， among which 11 cases died in the combined group and 2 cases died in the non union group. Results Compared with the death group， the survival group had lower procalcitonin， glucose and APACHE II scores （P< 0.05）. In the ROC curve， the accuracy was higher when the AUC was 0.7-0.9， and the area value was 1.0-0.5. When AUC=0.5， it was of no diagnostic value. Conclusion Combined serum procalcitonin and blood glucose can be used to assess the prognosis of critically ill patients with neuromuscular disorder. It is good for early intervention and lower fatality rate.

[Key words] Blood sugar； Calcitonin； Critical care myopathy； Diagnostic value

危重病性肌病（critical illness myopathy，CIM） 是1977年MacFarlane首次提出的[1]，是癥监护病房（ICU）中获得性肌无力的主要原因，以肢体近端弛缓性肌无力为主要临床症状，伴有四肢肌肉、颈肌、躯干肌、面部肌肉以及膈肌等受累，大部分患者存在呼吸机撤离困难，电生理检查显示肌纤维兴奋性减低，肌活检可观察到原发性肌肉损害[2]，本病根据骨骼肌病理的改变可分为粗肌丝肌球蛋白缺失、急性坏死性肌病、横纹肌溶解以及恶液质肌病等亚型。现代研究显示，ICU内危重疾病患者逐年增多，危重症患者于ICU内才能获得更高的存活率，这就使得更多的患者于ICU内接受长时间治疗[3]，CIM患病人数随之增多，这些患者的机械通气时间、住院时间均延长，在院内由于CIM所致的死亡率升高，本病主要发生于成人或儿童，大部分患者在接受治疗的过程中遗留长期功能障碍[4]。因此临床对于CIM的诊断或评估尤为关键，关乎患者的预后状况，同时也是实现患者治疗的重点。……