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Article(id=1322168852973204069, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168583854080893, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.08.004, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746460800000, receivedDateStr=2025-05-06, revisedDate=1774195200000, revisedDateStr=2026-03-23, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159219258, onlineDateStr=2026-10-28, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159219258, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159219257, creator=13701087609, updateTime=1793159219257, updator=13701087609, issue=Issue{id=1322168583854080893, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='8', pageStart='1241', pageEnd='1424', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159155095, creator='13701087609', updateTime=1793159155095, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1265, endPage=1273, ext={EN=ArticleExt(id=1322168853195502182, articleId=1322168852973204069, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis and the construction of its prediction model, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis,and to construct its predictive model.

Methods

By using the convenience sampling method,a total of 206 patients with acute pancreatitis admitted to Suqian Hospital of Jiangsu Provincial People's Hospital from March 2022 to November 2024 were selected as the research subjects.The clinical data of the patients were collected.They were divided into the stress hyperglycemia≥48 hours group and the stress hyperglycemia<48 hours group according to the duration.Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of the duration of stress hyperglycemia in patients.A risk prediction model for stress hyperglycemia of patients ≥48 hours was constructed based on the decision tree algorithm.The predictive efficacy of the Logistic regression model and the decision tree model was evaluated by using the receiver operating characteristic curve(ROC).

Results

Among 206 patients with acute pancreatitis,41 cases(19.90%) had stress hyperglycemia for ≥48 hours.There were statistically significant differences in hypertension,admission blood glucose level,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) scores,systemic inflammatory response syndrome(SIRS),pain,and nutritional risk between the stress hyperglycemia ≥48 hours group and the stress hyperglycemia <48 hours group(P<0.05).Multivariate Logistic regression analysis showed that the patients' admission blood glucose level,APACHEⅡ scores,SIRS,pain,and nutritional risk were the influencing factors of stress hyperglycemia ≥48 hours in patients with acute pancreatitis(P<0.05).The decision tree model screened out four influencing factors(pain,blood glucose level at admission,APACHEⅡ scores,and nutritional risk),with a prediction accuracy rate of 86.4%.The correlation between pain and stress hyperglycemia ≥48 hours in patients with acute pancreatitis was relatively stronger.When the pain score was >2 points,the admission blood glucose level was >13.07 mmol/L.The APACHEⅡ score was >7.The risk probability of stress hyperglycemia ≥48 hours in patients with acute pancreatitis was the highest(88.2%).The area under curve(AUC) of the Logistic regression model was 0.824,with a sensitivity of 82.9% and a specificity of 68.5%.The AUC predicted by the decision tree model was 0.828,with a sensitivity of 78.0% and a specificity of 77.6%.There was no statistically significant difference in terms of the predictive efficacy between the two models(Z=0.075,P=0.940).

Conclusions

The duration of stress hyperglycemia in patients with acute pancreatitis was influenced by multiple factors.Both the decision tree model and the Logistic regression model have good predictive value.However,the decision tree model demonstrates the interactive influence of various factors.Therefore,the two models could be used in combination to promote the targeted and specific natures of nursing intervention strategies from different levels.

, authors=Xuejian WANG, Xueru CHEN, Nana TANG, authorsList=Xuejian WANG, Xueru CHEN, Nana TANG, authorCompany=null, correspAuthors=Xuejian WANG, authorNote=null, correspAuthorsNote=
WANG Xuejian， E-mail：
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目的

分析急性胰腺炎病人应激性高血糖持续时间的影响因素，并构建其预测模型。

方法

采用便利抽样法，选取2022年3月—2024年11月江苏省人民医院宿迁医院收治的急性胰腺炎病人206例为研究对象。收集病人临床资料，根据应激性高血糖持续时间分为应激性高血糖≥48 h组和应激性高血糖<48 h组。采用单因素及多因素Logistic回归分析探讨急性胰腺炎病人应激性高血糖持续时间的影响因素，基于决策树算法构建病人应激性高血糖≥48 h的风险预测模型。采用受试者工作特征曲线（ROC）评估Logistic回归模型与决策树模型的预测效能。

结果

206例急性胰腺炎病人中，应激性高血糖≥48 h者41例（19.90%）。应激性高血糖≥48 h组与应激性高血糖<48 h组病人的高血压、入院血糖水平、急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、全身炎症反应综合征（SIRS）、疼痛、营养风险情况比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，病人入院血糖水平、APACHEⅡ评分、SIRS、疼痛、有营养风险是急性胰腺炎病人应激性高血糖≥48 h的影响因素（P<0.05）。决策树模型筛选出4个影响因素（疼痛、入院血糖水平、APACHEⅡ评分、营养风险），预测正确率为86.4%；疼痛与急性胰腺炎病人应激性高血糖≥48 h的相关性较强，当疼痛评分>2分、入院血糖水平>13.07 mmol/L且APACHEⅡ评分>7分时，急性胰腺炎病人发生应激性高血糖≥48 h的风险概率最高（88.2%）。Logistic回归模型的ROC曲线下面积（AUC）为0.824，敏感度为82.9%，特异度为68.5%。决策树模型预测的AUC为0.828，敏感度为78.0%，特异度为77.6%。两种模型预测效能比较，差异无统计学意义（Z=0.075，P=0.940）。

结论

急性胰腺炎病人应激性高血糖持续时间受多种因素影响，决策树模型与Logistic回归模型均具有良好预测价值，但决策树模型展现了各因素的交互影响作用，可联合使用两种模型，从不同层面促进护理干预策略的针对性及具体化。

, authors=王雪健, 陈雪茹, 汤娜娜, authorsList=王雪健, 陈雪茹, 汤娜娜, authorCompany=null, correspAuthors=王雪健, authorNote=null, correspAuthorsNote=
WANG Xuejian， E-mail：
王雪健，主管护师，本科，E-mail：
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authorNames=安友仲, journalName=中华危重病急救医学, refType=null, unstructuredReference=安友仲.应激性高血糖与营养治疗[J].中华危重病急救医学,2023,35(11):1147-1149., articleTitle=应激性高血糖与营养治疗, refAbstract=null), Reference(id=1322530513118671523, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, doi=null, pmid=null, pmcid=null, year=2024, volume=59, issue=13, pageStart=1608, pageEnd=1615, url=null, language=null, rfNumber=33, rfOrder=32, authorNames=何红梅, 喻芳, 林丽华, journalName=中华护理杂志, refType=null, unstructuredReference=何红梅,喻芳,林丽华,等.急性胰腺炎患者再喂养综合征风险预测模型的构建及护理启示[J].中华护理杂志,2024,59(13):1608-1615., articleTitle=急性胰腺炎患者再喂养综合征风险预测模型的构建及护理启示, refAbstract=null), Reference(id=1322530513185780388, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=5, pageStart=28, pageEnd=33, url=null, language=null, rfNumber=34, rfOrder=33, authorNames=张海波, 黄润, 吴芳, journalName=护理学报, refType=null, 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remark=1江苏省人民医院宿迁医院（宿迁市第一人民医院），江苏 223800)])], figs=[ArticleFig(id=1322530507884180085, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Figure 1, caption=The risk prediction decision tree model diagram of stress hyperglycemia ≥48 hours in patients with acute pancreatitis, figureFileSmall=ZfShsJ1JwdRsTLntVo6/kw==, figureFileBig=Kiakl9fyofOXL91+/njLiw==, tableContent=null), ArticleFig(id=1322530507968066166, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=图1, caption=急性胰腺炎病人应激性高血糖≥48 h的风险预测决策树模型图, figureFileSmall=ZfShsJ1JwdRsTLntVo6/kw==, figureFileBig=Kiakl9fyofOXL91+/njLiw==, tableContent=null), ArticleFig(id=1322530508060340855, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Figure 2, caption=ROC curves of the two models for predicting stress hyperglycemia≥48 hours in patients with acute pancreatitis, figureFileSmall=viD6DOeFmA48oKE2EO/a0A==, figureFileBig=z+zUYxZrJEKKUoE93rghdw==, tableContent=null), ArticleFig(id=1322530508144226936, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=图2, caption=2种模型预测急性胰腺炎病人应激性高血糖≥48 h的ROC曲线, figureFileSmall=viD6DOeFmA48oKE2EO/a0A==, figureFileBig=z+zUYxZrJEKKUoE93rghdw==, tableContent=null), ArticleFig(id=1322530508211335801, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Table 1, caption=

Univariate analysis of the influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类应激性高血糖≥48 h组（n=41）应激性高血糖<48 h组（n=165）统计值P
性别（例）男2592χ2=0.3640.546
女1673
年龄（岁）55.41±5.7753.94±5.39t=1.5390.125
体质指数（kg/m2）24.43±2.9923.95±2.69t=0.9960.320
吸烟史（例）有1452χ2=0.1040.747
无27113
饮酒史（例）有1034χ2=0.2800.597
无31131
高血压（例）有1638χ2=4.3430.037
无25127
高脂血症（例）有1748χ2=2.3280.127
无24117
主要病因（例）胆源性1880χ2=2.8210.420
高脂血症性1443
酒精性739
其他（自身免疫性、感染性）23
发病至入院时间 （h）14(9,21)13(11,16)Z=0.7940.427
入院血糖（mmol/L）13.52(10.42,16.73)10.68(8.97,13.06)Z=4.169<0.001
APACHEⅡ评分（分）8(7,10)7(6,9)Z=3.2260.001
SIRS（例）有1222χ2=6.0510.014
无29143
疼痛（分）3(3,4)2(2,3)Z=3.997<0.001
营养风险（例）有1525χ2=9.6420.002
无26140
), ArticleFig(id=1322530508303610490, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=表1, caption=

急性胰腺炎病人应激性高血糖持续时间影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类应激性高血糖≥48 h组（n=41）应激性高血糖<48 h组（n=165）统计值P
性别（例）男2592χ2=0.3640.546
女1673
年龄（岁）55.41±5.7753.94±5.39t=1.5390.125
体质指数（kg/m2）24.43±2.9923.95±2.69t=0.9960.320
吸烟史（例）有1452χ2=0.1040.747
无27113
饮酒史（例）有1034χ2=0.2800.597
无31131
高血压（例）有1638χ2=4.3430.037
无25127
高脂血症（例）有1748χ2=2.3280.127
无24117
主要病因（例）胆源性1880χ2=2.8210.420
高脂血症性1443
酒精性739
其他（自身免疫性、感染性）23
发病至入院时间 （h）14(9,21)13(11,16)Z=0.7940.427
入院血糖（mmol/L）13.52(10.42,16.73)10.68(8.97,13.06)Z=4.169<0.001
APACHEⅡ评分（分）8(7,10)7(6,9)Z=3.2260.001
SIRS（例）有1222χ2=6.0510.014
无29143
疼痛（分）3(3,4)2(2,3)Z=3.997<0.001
营养风险（例）有1525χ2=9.6420.002
无26140
), ArticleFig(id=1322530508379107963, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Table 2, caption=

Univariate Logistic regression analysis on the influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误Wald χ2值POR值95%CI
下限上限
高血压（有）0.7600.3704.2290.0402.1391.0364.415
入院血糖0.2230.05516.700<0.0011.2501.1231.391
APACHEⅡ评分0.2000.0688.5100.0041.2211.0681.396
SIRS（有）0.9890.4135.7500.0162.6901.1986.038
疼痛0.5240.13914.201<0.0011.6891.2862.218
营养风险（有）1.1730.3909.0320.0033.2311.5046.942
), ArticleFig(id=1322530508446216828, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=表2, caption=

急性胰腺炎病人应激性高血糖持续时间影响因素的单因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误Wald χ2值POR值95%CI
下限上限
高血压（有）0.7600.3704.2290.0402.1391.0364.415
入院血糖0.2230.05516.700<0.0011.2501.1231.391
APACHEⅡ评分0.2000.0688.5100.0041.2211.0681.396
SIRS（有）0.9890.4135.7500.0162.6901.1986.038
疼痛0.5240.13914.201<0.0011.6891.2862.218
营养风险（有）1.1730.3909.0320.0033.2311.5046.942
), ArticleFig(id=1322530508517519997, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Table 3, caption=

Assignment of variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
高血压有=1，无=0
入院血糖原值输入
APACHEⅡ评分原值输入
SIRS有=1，无=0
疼痛原值输入
营养风险有=1，无=0
), ArticleFig(id=1322530508584628862, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=表3, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
高血压有=1，无=0
入院血糖原值输入
APACHEⅡ评分原值输入
SIRS有=1，无=0
疼痛原值输入
营养风险有=1，无=0
), ArticleFig(id=1322530508651737727, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Table 4, caption=

Multivariate Logistic regression analysis on the influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误Wald χ2值POR值95%CI
下限上限
高血压0.7880.4523.0380.0812.1990.9075.335
入院血糖0.2430.06513.870<0.0011.2751.1221.450
APACHEⅡ评分0.1730.0844.2960.0381.1891.0091.401
SIRS1.1810.4915.7930.0163.2581.2458.526
疼痛0.5280.15910.9790.0011.6961.2412.318
营养风险1.0460.4575.2420.0222.8461.1636.969
), ArticleFig(id=1322530508718846592, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=表4, caption=

急性胰腺炎病人应激性高血糖持续时间影响因素的多因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回归系数标准误Wald χ2值POR值95%CI
下限上限
高血压0.7880.4523.0380.0812.1990.9075.335
入院血糖0.2430.06513.870<0.0011.2751.1221.450
APACHEⅡ评分0.1730.0844.2960.0381.1891.0091.401
SIRS1.1810.4915.7930.0163.2581.2458.526
疼痛0.5280.15910.9790.0011.6961.2412.318
营养风险1.0460.4575.2420.0222.8461.1636.969
), ArticleFig(id=1322530508802732673, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=EN, label=Table 5, caption=

Comparison of the performance of two models for predicting stress hyperglycemia ≥48 hours in patients with acute pancreatitis

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AUC标准误P95%CI敏感度（%）特异度（%）约登指数最佳临界值
下限上限
Logistic回归模型0.8240.036<0.0010.7540.89582.968.50.5140.151
决策树模型0.8280.039<0.0010.7520.90578.077.60.5560.181
), ArticleFig(id=1322530508899201666, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168852973204069, language=CN, label=表5, caption=

2种模型预测急性胰腺炎病人应激性高血糖≥48 h的效能比较

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AUC标准误P95%CI敏感度（%）特异度（%）约登指数最佳临界值
下限上限
Logistic回归模型0.8240.036<0.0010.7540.89582.968.50.5140.151
决策树模型0.8280.039<0.0010.7520.90578.077.60.5560.181
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急性胰腺炎病人应激性高血糖持续时间的影响因素及其预测模型的构建
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王雪健 , 陈雪茹 , 汤娜娜
护理研究 | 科研论著 2026,40(8): 1265-1273
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护理研究 |科研论著 2026 , 40 (8) : 1265 -1273
急性胰腺炎病人应激性高血糖持续时间的影响因素及其预测模型的构建
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王雪健 , 陈雪茹, 汤娜娜
作者信息
  • 1江苏省人民医院宿迁医院（宿迁市第一人民医院），江苏 223800
通讯作者:
WANG Xuejian， E-mail：
王雪健，主管护师，本科，E-mail：
Influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis and the construction of its prediction model
Xuejian WANG , Xueru CHEN, Nana TANG
Affiliations
  • 1Suqian Hospital of Jiangsu Provincial People's Hospital(Suqian First People's Hospital), Jiangsu 223800 China
    • Corresponding Author:
    WANG Xuejian， E-mail：
出版时间: 2026-04-25 doi: 10.12102/j.issn.1009-6493.2026.08.004
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摘要
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目的

分析急性胰腺炎病人应激性高血糖持续时间的影响因素，并构建其预测模型。

方法

采用便利抽样法，选取2022年3月—2024年11月江苏省人民医院宿迁医院收治的急性胰腺炎病人206例为研究对象。收集病人临床资料，根据应激性高血糖持续时间分为应激性高血糖≥48 h组和应激性高血糖<48 h组。采用单因素及多因素Logistic回归分析探讨急性胰腺炎病人应激性高血糖持续时间的影响因素，基于决策树算法构建病人应激性高血糖≥48 h的风险预测模型。采用受试者工作特征曲线（ROC）评估Logistic回归模型与决策树模型的预测效能。

结果

206例急性胰腺炎病人中，应激性高血糖≥48 h者41例（19.90%）。应激性高血糖≥48 h组与应激性高血糖<48 h组病人的高血压、入院血糖水平、急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、全身炎症反应综合征（SIRS）、疼痛、营养风险情况比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，病人入院血糖水平、APACHEⅡ评分、SIRS、疼痛、有营养风险是急性胰腺炎病人应激性高血糖≥48 h的影响因素（P<0.05）。决策树模型筛选出4个影响因素（疼痛、入院血糖水平、APACHEⅡ评分、营养风险），预测正确率为86.4%；疼痛与急性胰腺炎病人应激性高血糖≥48 h的相关性较强，当疼痛评分>2分、入院血糖水平>13.07 mmol/L且APACHEⅡ评分>7分时，急性胰腺炎病人发生应激性高血糖≥48 h的风险概率最高（88.2%）。Logistic回归模型的ROC曲线下面积（AUC）为0.824，敏感度为82.9%，特异度为68.5%。决策树模型预测的AUC为0.828，敏感度为78.0%，特异度为77.6%。两种模型预测效能比较，差异无统计学意义（Z=0.075，P=0.940）。

结论

急性胰腺炎病人应激性高血糖持续时间受多种因素影响，决策树模型与Logistic回归模型均具有良好预测价值，但决策树模型展现了各因素的交互影响作用，可联合使用两种模型，从不同层面促进护理干预策略的针对性及具体化。

急性胰腺炎  /  应激性高血糖  /  持续时间  /  影响因素  /  决策树  /  预测模型
Objective

To analyze the influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis,and to construct its predictive model.

Methods

By using the convenience sampling method,a total of 206 patients with acute pancreatitis admitted to Suqian Hospital of Jiangsu Provincial People's Hospital from March 2022 to November 2024 were selected as the research subjects.The clinical data of the patients were collected.They were divided into the stress hyperglycemia≥48 hours group and the stress hyperglycemia<48 hours group according to the duration.Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of the duration of stress hyperglycemia in patients.A risk prediction model for stress hyperglycemia of patients ≥48 hours was constructed based on the decision tree algorithm.The predictive efficacy of the Logistic regression model and the decision tree model was evaluated by using the receiver operating characteristic curve(ROC).

Results

Among 206 patients with acute pancreatitis,41 cases(19.90%) had stress hyperglycemia for ≥48 hours.There were statistically significant differences in hypertension,admission blood glucose level,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) scores,systemic inflammatory response syndrome(SIRS),pain,and nutritional risk between the stress hyperglycemia ≥48 hours group and the stress hyperglycemia <48 hours group(P<0.05).Multivariate Logistic regression analysis showed that the patients' admission blood glucose level,APACHEⅡ scores,SIRS,pain,and nutritional risk were the influencing factors of stress hyperglycemia ≥48 hours in patients with acute pancreatitis(P<0.05).The decision tree model screened out four influencing factors(pain,blood glucose level at admission,APACHEⅡ scores,and nutritional risk),with a prediction accuracy rate of 86.4%.The correlation between pain and stress hyperglycemia ≥48 hours in patients with acute pancreatitis was relatively stronger.When the pain score was >2 points,the admission blood glucose level was >13.07 mmol/L.The APACHEⅡ score was >7.The risk probability of stress hyperglycemia ≥48 hours in patients with acute pancreatitis was the highest(88.2%).The area under curve(AUC) of the Logistic regression model was 0.824,with a sensitivity of 82.9% and a specificity of 68.5%.The AUC predicted by the decision tree model was 0.828,with a sensitivity of 78.0% and a specificity of 77.6%.There was no statistically significant difference in terms of the predictive efficacy between the two models(Z=0.075,P=0.940).

Conclusions

The duration of stress hyperglycemia in patients with acute pancreatitis was influenced by multiple factors.Both the decision tree model and the Logistic regression model have good predictive value.However,the decision tree model demonstrates the interactive influence of various factors.Therefore,the two models could be used in combination to promote the targeted and specific natures of nursing intervention strategies from different levels.

acute pancreatitis  /  stress hyperglycemia  /  duration  /  influencing factors  /  decision tree  /  predictive model
王雪健, 陈雪茹, 汤娜娜. 急性胰腺炎病人应激性高血糖持续时间的影响因素及其预测模型的构建. 护理研究, 2026 , 40 (8) : 1265 -1273 . DOI: 10.12102/j.issn.1009-6493.2026.08.004
Xuejian WANG, Xueru CHEN, Nana TANG. Influencing factors of the duration of stress hyperglycemia in patients with acute pancreatitis and the construction of its prediction model[J]. Chinese Nursing Research, 2026 , 40 (8) : 1265 -1273 . DOI: 10.12102/j.issn.1009-6493.2026.08.004
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急性胰腺炎是一种以胰腺局部破坏和炎症或全身炎症反应为特征的疾病[1]。全球疾病负担（global burden of disease，GBD）数据显示，1990—2021年，全球胰腺炎病例从173万例增加到275万例，增长率59%，死亡人数从68 490人增加到122 416人，增加了78.7%[2]。急性胰腺炎病人发病时机体常处于应激状态，交感神经兴奋，大量儿茶酚胺释放，胰高血糖素等升糖激素分泌增加，同时炎症介质干扰胰岛素信号传导通路，进而引发应激性高血糖（stress hyperglycemia，SHG）[3]。应激性高血糖是指在无糖尿病病史个体中，当发生严重创伤、感染等机体应激状态下产生的血糖急性增高现象[4]。研究表明，急性胰腺炎病人应激性高血糖发生率高达28.5%，应激性高血糖与急性胰腺炎继发糖尿病独立相关[5]。应激性高血糖还是急性胰腺炎病人临床结局和预后不良的重要独立危险因素[6]。尽管目前对于急性胰腺炎应激性高血糖已有一定认识，但研究多聚焦于应激性高血糖发生率及对预后的影响，缺乏对应激性高血糖持续时间的关注。对于急性胰腺炎病人而言，持续应激性高血糖会加剧氧化应激和内皮细胞损伤，导致胰腺微循环障碍，加重局部坏死和全身炎症反应，增加胰腺及腹腔感染风险，还会抑制机体免疫功能，影响病情恢复；持续高血糖也可能诱发胰岛素分泌功能不可逆损伤，增加远期糖尿病发生风险[7-8]。研究应激性高血糖持续时间的影响因素可能更有助于通过优化具体的预防干预策略减少应激性高血糖对急性胰腺炎病人的不利影响。基于此，本研究旨在探索急性胰腺炎病人应激性高血糖持续时间的影响因素，并构建决策树预测模型，以期为临床制定分层管理策略提供依据，进而优化个体化血糖管理与干预进程，通过靶向管理缩短应激性高血糖持续时间，减少应激性高血糖的不利影响，促进病人预后改善。现报告如下。
1　对象与方法
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1.1　对象
采用便利抽样法，选取2022年3月—2024年11月我院收治的急性胰腺炎病人为研究对象。样本量采用样本量估算经验准则[9]，所需样本量为自变量数的10~15倍，本研究纳入14个自变量，则样本量需要140~210例，预计样本缺失10%，则需要样本量156~234例，本研究选取211例病人，符合样本需求范围。纳入标准：急性胰腺炎符合《中国急性胰腺炎诊治指南（2021）》[10]中的诊断标准；根据入院血糖持续监测情况，判定存在应激性高血糖；年龄>18岁；发病至入院时间≤48 h；接受血糖监测。排除标准：既往有糖尿病；存在甲状腺功能亢进、肾上腺功能性疾病等干扰血糖代谢的病史；存在严重心脑血管疾病；合并肝、肾、肺功能障碍；合并恶性肿瘤者；研究期间病死者；入院低血糖（血糖水平低于2.8 mmol/L）；近6个月有糖皮质激素、免疫抑制剂应用史；妊娠/哺乳期女性。本研究经医院医学伦理委员会审核批准（编号：2022-SR-0158）。
1.2　研究工具
根据《中国急性胰腺炎诊治指南（2021）》[10]，在文献调研、专家咨询、临床实践观察的基础上，结合急性胰腺炎病人情况设计临床资料调查表，主要包括性别、年龄、体质指数、吸烟史、饮酒史、高血压、高脂血症、主要病因、发病至入院时间、入院血糖水平、急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、全身炎症反应综合征（SIRS）、疼痛、营养风险。其中APACHEⅡ由Knaus等[11]修订，包括急性生理学、慢性健康、年龄3个部分，总分0~71分，评分高提示病情重。SIRS依据美国胸科医师学会与重症医学学会联席会议诊断标准，以下出现≥2项可判定SIRS[12]：体温<36 ℃或>38 ℃；心率>90/min；呼吸频率>20/min，或出现动脉血二氧化碳分压<32 mmHg；白细胞计数>12×109/L或者<4×109/L，或者幼稚型细胞>10%。疼痛评估依据《疼痛评估量表应用的中国专家共识(2020版)》[13]，采用视觉模拟评分法（VAS），总分0~10分，评分高提示疼痛程度重。营养风险评估采用Kondrup等[14]开发的营养风险筛查2002（NRS 2002），包括年龄、营养状态、疾病程度3个维度，总分0~7分，≥3分则有营养风险。
1.3　应激性高血糖判定标准及持续时间划分
根据《危重症病人血糖管理专家共识》[15]的应激性高血糖诊断标准进行判定：非糖尿病病人在机体应激状态下，入院后随机2次或2次以上空腹血糖≥7.0 mmol/L或随机血糖≥11.1 mmol/L。采用CGMS Gold动态血糖监测系统进行血糖监测，根据《住院成人高血糖病人血糖监测医护协议处方共识》[16]，需4~6 h对病人进行1次血糖监测。《中国血糖监测临床应用指南（2021年版）》[17]指出，需加强对血糖增高病人的葡萄糖水平监测；《危重症病人血糖管理专家共识》[15]推荐对于血糖异常者监测频率应为每小时1次。本研究对于急性胰腺炎病人入院后血糖水平的监测频率为每小时1次。根据持续监测情况给予降糖干预，并根据文献标准[18-19]对应激性高血糖持续时间进行划分，应激性高血糖≥48 h判定为持续性应激性高血糖，应激性高血糖<48 h判定为短暂性应激性高血糖，据此划分为应激性高血糖≥48 h组、应激性高血糖<48 h组。
1.4　资料收集方法
由消化内科2名经过统一规范培训的护理人员通过医院电子病历系统、与家属交谈、临床护理记录收集并整理急性胰腺炎病人的临床资料。护理人员掌握纳入与排除标准，熟悉收集内容，并确保所有资料的收集均充分保护病人隐私。
1.5　质量控制
本研究严格遵循纳入及排除标准选择病例，采用统一的方式收集资料，确保收集过程规范化、统一性，并与家属取得沟通，提高资料完整度；数据录入由未参与收集的2名研究者采用双人核对录入的方式建立数据表，确保数据准确性；本研究遵循《赫尔辛基宣言》要求，保护病人隐私，践行自愿原则、有益无害原则。
1.6　统计学方法
采用SPSS 26.0统计软件分析数据。定性资料以例数、百分比（%）表示，采用χ2检验。符合正态分布的定量资料以均数±标准差（x±s）表示，采用t检验；不符合正态分布的定量资料以中位数（四分位数）[M(P25,P75)]表示，采用Mann-Whitney U检验。采用Logistic回归分析急性胰腺炎病人应激性高血糖≥48 h的影响因素；进一步构建决策树模型，通过卡方自动交互检测法（CHAID）实现树生长，受试者工作特征曲线（ROC）评估模型预测效能，模型比较采用Delong检验。以P<0.05为差异有统计学意义。
2　结果
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2.1　急性胰腺炎病人一般资料
本研究纳入了211例急性胰腺炎病人，研究过程中有5例失访，其中2例疾病状况严重且依从性欠佳，无法配合完成所有评估，3例部分资料数据缺失。最终206例急性胰腺炎病人纳入研究，应激性高血糖≥48 h病人41例（19.90%）；男117例（56.80%），女89例（43.20%）；年龄46~75（54.24±5.49）岁；体质指数为18.5~32.9（24.0±2.7）kg/m2；主要病因：胆源性98例（47.57%），高脂血症性57例（27.67%），酒精性46例（22.33%），其他（自身免疫性、感染性）5例（2.43%）；发病至入院时间[13(11,17)]h；入院血糖[10.94(9.11,14.14)]mmol/L；APACHEⅡ评分为[7(6,9)]分；疼痛评分为[2(2,4)]分。
2.2　急性胰腺炎病人应激性高血糖持续时间影响因素的单因素分析（见表1）
2.3　急性胰腺炎病人应激性高血糖持续时间影响因素的单因素Logistic回归分析（见表2）
2.4　急性胰腺炎病人应激性高血糖持续时间影响因素的多因素Logistic回归分析
以急性胰腺炎病人应激性高血糖持续时间为因变量（应激性高血糖≥48 h=1，应激性高血糖<48 h=0），以单因素分析中差异有统计学意义的变量（高血压、入院血糖、APACHEⅡ评分、SIRS、疼痛、营养风险）为自变量，进行多因素Logistic回归分析，变量赋值方式见表3，结果见表4。
2.5　构建急性胰腺炎病人应激性高血糖≥48 h风险预测的决策树模型
以急性胰腺炎病人应激性高血糖持续时间为因变量（应激性高血糖≥48 h=1，应激性高血糖<48 h=0），将单因素分析中差异有统计学意义的6个自变量（高血压、入院血糖、APACHEⅡ评分、SIRS、疼痛、营养风险）纳入决策树模型进行分析，设置最大树深为3层。决策树模型显示，决策树生长共3层，有6个终端节点，总节点数为10个，筛选出4个影响因素，进入决策树模型的影响因素有疼痛、入院血糖、APACHEⅡ评分、营养风险，这4个因素构成了决策树模型的节点变量，也是决策树模型分析显示的急性胰腺炎病人应激性高血糖≥48 h的影响因素，且模型结果显示预测正确率为86.4%，说明模型预测效果良好，见图1。
模型主要结果：1）决策树首层为疼痛评分，表明疼痛与急性胰腺炎病人应激性高血糖≥48 h的相关性更强，疼痛评分>2分的急性胰腺炎病人应激性高血糖≥48 h的概率（32.4%）高于疼痛评分≤2分的病人（7.7%）（P<0.05）。2）入院血糖水平与应激性高血糖≥48 h明显相关，当疼痛评分>2分、入院血糖水平>13.07 mmol/L且APACHEⅡ评分>7分时，急性胰腺炎病人发生应激性高血糖≥48 h的风险概率最高（88.2%）。3）当疼痛评分>2分但入院血糖水平≤10.09 mmol/L时，若存在营养风险也会增加应激性高血糖≥48 h的发生概率（P<0.05）。
2.6　Logistic回归模型与决策树模型的预测效能
由于多因素Logistic回归分析未显示高血压对应激性高血糖≥48 h的明显影响，Logistic回归模型纳入5个变量（入院血糖、APACHEⅡ评分、SIRS、疼痛、营养风险）。结果显示，Logistic回归模型预测急性胰腺炎病人应激性高血糖≥48 h的ROC曲线下面积（AUC）为0.824，敏感度为82.9%，特异度为68.5%；决策树模型预测应激性高血糖≥48 h的AUC为0.828，敏感度为78.0%，特异度为77.6%。2种模型对急性胰腺炎病人应激性高血糖≥48 h均具有良好的预测效能，且2种模型预测效能比较差异无统计学意义（Z=0.075，P=0.940），见表5、图2。
3　讨论
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3.1　急性胰腺炎病人应激性高血糖持续时间情况
本研究结果显示，206例急性胰腺炎病人中应激性高血糖≥48 h病人41例，占19.90%，稍低于Yang等[18]报道的持续性应激性高血糖发生率（28.86%）。可能与样本量有关，Yang等[18]研究纳入1 792例急性胰腺炎病人，有499例（27.8%）出现应激性高血糖，其中144例病人应激性高血糖≥48 h。Kennedy等[20]研究显示，急性胰腺炎病人持续性应激性高血糖发生率高达46.87%（15/32）。因此，样本量差异可能使得研究报道结果之间出现差异。Yang等[21]研究还指出，由于葡萄糖耐量以及疾病的发病情况、个体差异，病人的急性和持续反应可能也会有所不同，报道还显示，应激性高血糖持续可诱导细胞内葡萄糖超负荷和急性糖毒性，导致氧化应激、炎症、内皮功能障碍，增加急性疾病病人休克、感染、器官衰竭的风险以及住院时间延长的可能性。有研究发现，应激性高血糖≥48 h与更严重的急性胰腺炎相关，应激性高血糖≥48 h病人的死亡率（9.0%）明显高于应激性高血糖<48 h的病人（3.6%），且死亡率随高血糖的持续时间延长而显著增加[18]。因此，有必要进一步探索急性胰腺炎病人应激性高血糖持续时间的影响因素，为临床制定分层靶向管理策略提供依据，以期缩短应激性高血糖持续时间，降低应激性高血糖的负面影响，促进急性胰腺炎病人预后改善。
3.2　急性胰腺炎病人应激性高血糖持续时间的影响因素
3.2.1　入院血糖水平
本研究结果显示，入院血糖水平是急性胰腺炎病人应激性高血糖≥48 h的影响因素。提示入院血糖水平高的病人发生应激性高血糖≥48 h的风险性更大。急性胰腺炎发病早期，血糖高水平常反映机体处于明显的应激状态，该状态下可伴随下丘脑-垂体-肾上腺轴（HPA轴）过度激活，升糖激素分泌增加，高血糖还可加剧氧化应激、炎症刺激、胰岛素抵抗，造成“高血糖-炎症-胰岛素抵抗”恶性循环，加剧糖代谢紊乱[22]，进而延长应激性高血糖持续时间。Jin等[23]研究指出，急性胰腺炎病人存在胰岛功能受损状态，高血糖刺激会导致血糖调控能力“失代偿”，难以快速纠正。《危重症病人血糖管理专家共识》[15]推荐对于血糖异常者监测频率应为每小时1次，而采用动态血糖监测[24]能够让医护人员实时掌握病人血糖变化轨迹，及早发现异常，给予对症处理，缩短应激性高血糖时间。
3.2.2　APACHEⅡ评分
本研究结果显示，APACHEⅡ评分是急性胰腺炎病人应激性高血糖≥48 h的影响因素。提示APACHEⅡ评分高的病人发生应激性高血糖≥48 h的风险性更大。APACHEⅡ评分高反映病人急性生理与慢性健康状况更严重，胰腺组织炎症反应更强烈，会直接干扰胰岛素的信号传导通路，降低外周组织对胰岛素的敏感性，阻碍葡萄糖摄取和利用[25]，导致血糖持续升高同时难以在短时间内恢复正常，故增加了应激性高血糖≥48 h的可能性。Yang等[18]研究也显示，急性胰腺炎应激性高血糖≥48 h病人的APACHEⅡ评分显著高于应激性高血糖<48 h的病人。因此，针对急性胰腺炎病人的血糖管理策略可纳入APACHEⅡ评分作为重要指标，从急性生理与慢性健康状况层面优化护理干预方案。马海平等[26]研究显示，护士主导护理模式可提高护理有效性。
3.2.3　SIRS
本研究结果显示，SIRS是急性胰腺炎病人应激性高血糖≥48 h的影响因素。提示合并SIRS的病人发生应激性高血糖≥48 h的风险性更大。SIRS的核心特征是促炎细胞因子的暴发性释放，抑制胰岛素受体底物磷酸化，破坏胰岛β细胞功能，加剧胰岛素抵抗。邵素花等[27]研究表明，胰岛素抵抗持续加剧将影响机体代谢与组织蛋白的分解，造成机体免疫受损、抗休克与抗感染能力降低，影响组织修复速度。故可能增加应激性高血糖≥48 h的风险。朱海宏等[28]报道显示，急性胰腺炎早期，诱发SIRS的因素（胰腺感染、胰腺组织缺血再灌注、胰腺自身炎症等）可同时存在，使得SIRS持续时间长。故推测这也是SIRS影响应激性高血糖持续时间的原因。因此，针对合并SIRS的急性胰腺炎病人，临床干预应通过动态监测、分层管理及多学科协作，打破炎症相关恶性循环，缩短应激性高血糖时间。
3.2.4　疼痛
本研究结果显示，疼痛评分是急性胰腺炎病人应激性高血糖≥48 h的影响因素。提示疼痛评分高的病人发生应激性高血糖≥48 h的风险性更大。疼痛是急性胰腺炎典型症状之一，疼痛本身可促进神经源性介质释放，加剧胰腺损伤[29]；疼痛还可激活HPA轴促使皮质醇释放，促进肌肉蛋白分解，抑制脂肪组织对葡萄糖的摄取，增强肝内糖异生关键酶，导致血糖持续高水平。田恬等[30]研究也表明，疼痛与急性胰腺炎后新发糖尿病有关，部分病人在治疗干预后胰腺功能并不能完全恢复，导致血糖稳态改变，间接反映了疼痛对血糖增高影响的持续性。因此，护理人员应提高对疼痛管理的意识，加强疼痛管理与监护，通过多模态、个体化疼痛管理方案缓解病人疼痛程度，减轻胰腺组织损伤，促进血糖调节，逆转应激性高血糖持续状态。
3.2.5　营养风险
本研究结果还显示，有营养风险是急性胰腺炎病人应激性高血糖≥48 h的影响因素。提示有营养风险的病人发生应激性高血糖≥48 h的风险性更大。急性胰腺炎发病后，机体高分解代谢状态使得营养需求增加，而有营养风险状态下供给无法满足，机体会动员蛋白质、脂肪实现糖异生，血糖生成增多，同时营养缺乏下胰岛素合成不足，葡萄糖摄取利用率降低，血糖调节失衡，导致应激性高血糖持续[31]。有营养风险会影响机体微循环，病人对药物的吸收、代谢可能改变，可能阻碍降糖药物到达作用部位，影响控糖效果[6]。因此，护理人员应加强对急性胰腺炎病人的营养监测。安友仲[32]研究指出，对于应激性高血糖的监测和强化控制，主要在于调节代谢，同时保护病人脏器功能，应遵循“补不足、损有余、慎营养”的理念，调整营养物质结构。何红梅等[33]研究表明，对于急性胰腺炎病人进行肠内营养支持时，可从肠内营养混悬液、米汤、蛋汤、蔬菜汤过程着手，起始量每次100 mL，血糖稳定后逐渐增加至每次150~200 mL，而后过渡至半流质饮食。
3.3　急性胰腺炎病人应激性高血糖持续时间影响因素的Logistic回归模型与决策树预测模型
本研究Logistic回归模型包括5个变量（入院血糖、APACHE Ⅱ评分、SIRS、疼痛、营养风险），模型预测急性胰腺炎病人应激性高血糖≥48 h的AUC为0.824，敏感度为82.9%，特异度为68.5%。提示Logistic回归模型对应激性高血糖≥48 h具有良好预测效能。决策树模型筛选出4个影响因素（入院血糖、APACHE Ⅱ评分、疼痛、营养风险），模型预测正确率为86.4%，预测AUC为0.828，敏感度为78.0%，特异度为77.6%。提示决策树预测模型的综合效能良好。而两种模型预测效能比较差异无统计学意义，说明预测效果相当。但决策树模型展现了各因素的交互影响作用，并直观以树形图形式展示变量之间的关系，能划分出有不同特征的层级，便于临床医护人员识别需要加强重视的人群，这有助于弥补Logistic回归不能直观展现交互作用的不足。本研究根据决策树模型结果，发现疼痛与急性胰腺炎病人应激性高血糖≥48 h的相关性较强，且在疼痛评分>2分、入院血糖水平>13.07 mmol/L且APACHE Ⅱ评分>7分时，急性胰腺炎病人发生应激性高血糖≥48 h的风险概率最高（88.2%）。而当疼痛评分>2分但入院血糖水平<10.09 mmol/L时，有营养风险会增加应激性高血糖≥48 h的发生概率。因此，对于入院血糖水平<10.09 mmol/L的病人同样要给予重视，进一步加强营养风险监测与营养管理。张海波等[34]应用医疗失效模式与效应分析优化应激性高血糖管理发现效果显著。而基于本研究的风险因素探讨，后续可能通过医疗失效模式与效应分析，探索基于风险因素的监测与管理下的应激性高血糖管理效果，以进一步验证、深化研究结果，为临床实践提供更全面的依据。
4　小结
收起
急性胰腺炎病人应激性高血糖≥48 h受多因素影响，决策树模型与Logistic回归模型均具有良好预测价值，但决策树模型展现了各因素的交互影响作用，因此可联合使用两种模型，从不同层面促进护理干预策略的针对性及具体化。本研究不足在于为单中心研究，急性胰腺炎病例有限，未针对不同病因进行分类研究，尚不明确急性胰腺炎不同病因病人的应激性高血糖持续时间影响因素是否存在不同，故后续将进一步探索。

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doi: 10.12102/j.issn.1009-6493.2026.08.004
  • 接收时间：2025-05-06
  • 首发时间：2026-10-28
  • 出版时间：2026-04-25
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  • 收稿日期：2025-05-06
  • 修回日期：2026-03-23
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    1江苏省人民医院宿迁医院（宿迁市第一人民医院），江苏 223800

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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