应激性高血糖比率在脓毒症患者预后评估中的研究进展

Research Progress on the Stress Hyperglycemia Ratio in Prognostic Evaluation of Patients with Sepsis

摘要: 脓毒症患者常出现并发的应激性高血糖，但单次血糖测定很难区分升高是急性应激导致，还是患者本身存在慢性高血糖基础。应激性高血糖比率(SHR)的计算逻辑是将急性期血糖数值，与糖化血红蛋白推算得到的估算平均血糖作对比，可在一定程度上校正不同个体的基础糖代谢差异，更真实地反映急性代谢应激的实际程度。最近几年，针对SHR的研究已经从心脑血管急症领域逐步延伸至脓毒症方向。目前已有的研究数据显示，SHR数值升高与脓毒症患者的院内死亡率、短期及长期不良预后均存在相关性，同时还与脓毒症相关急性肾损伤、急性呼吸窘迫综合征等器官并发症的风险上升有关，部分队列研究甚至观察到二者呈U型或J型的非线性关联。从机制角度分析，SHR所反映的代谢异常问题，可能涉及氧化应激、线粒体功能障碍、内皮损伤、免疫失衡等多类病理生理过程。需要说明的是，当前已有研究多以回顾性设计为主，SHR的计算方式、阈值界定标准以及动态监测方案尚未形成统一共识。本文围绕SHR的概念与测算方法、病理生理机制、临床研究证据及现存问题展开综述，可为脓毒症患者的代谢风险分层工作提供参考依据。

Abstract: Sepsis patients often develop concurrent stress hyperglycemia. However, a single blood glucose measurement is insufficient to distinguish whether the elevation is caused by acute stress or pre-existing chronic hyperglycemia in the patient. The stress hyperglycemia ratio (SHR) is calculated by comparing acute-phase blood glucose levels with the estimated average blood glucose derived from glycated hemoglobin. This approach can partially correct for individual differences in baseline glucose metabolism and more accurately reflect the actual magnitude of acute metabolic stress. In recent years, research on SHR has gradually expanded from the field of acute cardiovascular and cerebrovascular diseases to sepsis. Existing evidence indicates that elevated SHR is associated with in-hospital mortality, short-term and long-term adverse outcomes in sepsis patients, as well as an increased risk of sepsis-related organ complications such as acute kidney injury and acute respiratory distress syndrome. Some cohort studies have even observed a U-shaped or J-shaped nonlinear relationship between SHR and clinical outcomes. Mechanistically, the metabolic abnormalities reflected by SHR may involve multiple pathophysiological processes, including oxidative stress, mitochondrial dysfunction, endothelial injury, and immune dysregulation. Notably, most current studies are retrospective in design, and no consensus has been reached regarding the calculation method, threshold definition, and dynamic monitoring protocol of SHR. This article reviews the concept, calculation method, pathophysiological mechanism, clinical evidence, and existing controversies of SHR, aiming to provide a reference for metabolic risk stratification in patients with sepsis.