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目的:研究糖化血红蛋白(glycated haemoglobin A1c, HbA1c)是否可以作为预测流感肺炎患者死亡风险的指标。方法:本研究为单中心回顾性研究，纳入2017年至2019年首都医科大学附属北京朝阳manbet官网登录 急诊留观或住院部的流感肺炎患者。收集性别、年龄、基础疾病、流感病毒核酸或抗原结果、胸片或胸CT报告、血常规结果、生化指标、HbA1c和降钙素原(procalcitonin, PCT)等信息，依据28 d死亡分为生存组和死亡组。比较两组之间的差异，并采用Cox回归分析28 d死亡的危险因素。结果:本研究纳入研究对象122例，分为生存组94 (77.0 %)例和死亡组28 (23.0 %)例。单因素分析发现，与生存组相比，死亡患者淋巴细胞计数[0.49 (0.33, 0.73) vs. 0.77 (0.49, 1.23) ×10 9/L, Z= - 3.008, P=0.003]降低，HbA1c水平[6.5 (6.1, 7.1) vs. 6.1 (5.7, 6.8) %, Z= 2.203, P= 0.028]和PCT水平[0.64 (0.20, 6.43) vs. 0.16 (0.05, 0.87) μg/L, Z=2.594, P=0.009]升高。Cox多因素回归和生存分析发现，校正年龄后，淋巴细胞计数( HR=0.260, 95% CI: 0.087 ~ 0.773, P=0.015)和HbA1c ( HR=1.295, 95% CI: 1.007 ~ 1.666, P=0.044)是28 d死亡的独立危险因素。 结论:HbA1c可作为预测流感肺炎患者28 d死亡的独立危险因素。

Objective:To investigate whether glycated haemoglobin A1c (HbA1c) can be used as a predictor of mortality risk in patients with influenza pneumonia.Methods:This study was a single-center retrospective study, and enrolled patients with influenza pneumonia in the Emergency Department and in-patient departments of Beijing Chaoyang Hospital, Capital Medical University from 2017 to 2019. Gender, age, underlying diseases, influenza virus nucleic acid or antigen results, chest X-ray or chest CT reports, routine blood test, biochemical indicators, HbA1c and procalcitonin (PCT) were collected, and all subjects were divided into survival and death groups based on 28-day mortality. The differences between the two groups were compared and Cox regression was used to analyze risk factors for 28-day mortality.Results:In this study, 122 patients with influenza pneumonia were included, and 94 (77.0%) cases were divided into the survival group and 28 (23.0%) cases into the death group. Univariate analysis showed that lymphocyte counts [0.49 (0.33, 0.73) vs. 0.77 (0.49, 1.23) ×10 9/L, Z= -3.008, P=0.003] were lower and HbA1c levels [6.5 (6.1, 7.1) vs. 6.1 (5.7, 6.8) %, Z= 2.203, P= 0.028] and PCT levels [0.64 (0.20, 6.43) vs. 0.16 (0.05, 0.87) μg/L, Z=2.594, P=0.009] were higher in dead patients compared with those in the survivors. Cox multivariate regression and survival analysis found that after adjusting for age, lymphocyte counts ( HR=0.260, 95% CI: 0.087-0.773, P=0.015) and HbA1c levels ( HR=1.295, 95% CI:1.007-1.666, P=0.044) were independent risk factors for 28-day mortality. Conclusions:HbA1c is an independent risk factor for predicting 28-day mortality in patients with influenza pneumonia.