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在住院肺炎中,并非所有高血糖都是平等的
Cherie Choong1,2, Megan Dharma3,4,5, Rahul D Barmanray1,3,4,5
1Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia.
对社区获得性肺炎 (CAP) 的皮质类固醇治疗降低了死亡率,但增加了高血糖症的风险. 研究表明有两种类型的高血糖症,对患者的结果有不同的影响.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 传染性疾病 传染性疾病
背景情况:
- 社区获得性肺炎 (CAP) 是一个重要的全球健康问题,导致大量住院和死亡.
- 对CAP的皮质类固醇治疗降低了30天死亡率,但显著增加了高血糖症的风险.
- 在CAP中高血糖可能源于不同的机制:炎症介导与皮质类固醇诱导.
研究的目的:
- 在CAP中探索炎症介导和皮质类固醇诱导的高血糖症的差异性影响.
- 研究早期血糖控制在管理这些独特的高血糖亚型中的作用.
- 突出需要标准化定义和针对CAP相关高血糖的有针对性的管理策略.
主要方法:
- 审查现有的文献和来自COVID-19队伍的证据.
- 分析高血糖,皮质类固醇使用,疾病严重程度和死亡率之间的关联.
- 检查血糖控制对不同高血糖情境中的并发症的影响.
主要成果:
- 有证据表明,皮质类固醇诱导的高血糖症可能不会增加死亡风险,与炎症介导的高血糖症不同.
- 在COVID-19队伍中,与皮质类固醇使用相关的高血糖与疾病严重程度和更长的住院时间相关,而不是死亡率.
- 早期血糖控制的有效性已被确立为炎症介导的高血糖症,但对于皮质类固醇诱导的高血糖症仍然不确定.
结论:
- 区分由炎症介导和皮质类固醇诱导的高血糖症对于有效的临床管理至关重要.
- 需要进一步的研究来确定最佳的葡萄糖标和治疗策略,用于皮质类固醇相关的高血糖症.
- 标准化高血糖的定义对于推进CAP的研究和临床实践至关重要.
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