新发儿童1型糖尿病酮症酸中毒与重症儿童应激性高血糖的鉴别诊断

Differential diagnosis of ketoacidosis in newly diagnosed type 1 diabetic and stress hyperglycemia in critically ill pediatric patients

目的探讨新发儿童1型糖尿病酮症酸中毒与重症儿童应激性高血糖的鉴别诊断指标。方法前瞻性研究30例1型糖尿病酮症酸中毒(DKA组)患儿[年龄(6.5±3.6)岁]和20例重症应激性高血糖(SHG组)患儿[年龄(5.8±3.1)岁]的鉴别诊断指标,分别比较两组糖化血红蛋白(HbA1c)、空腹血糖(FBG)、二氧化碳结合力(CO2-CP)、阴离子间隙(AG)、空腹C-肽(FCP)、空腹胰岛素(FINS)、胰岛素抵抗指数(IRI)、皮质醇(COR)及是否依赖胰岛素治疗。对照组(C组)30例为健康体检儿童,年龄(6.1±3.4)岁。结果DKA组和SHG组均有高血糖、AG和皮质醇升高,CO2-CP降低。DKA组HbA1c显著高于正常对照和SHG组(P均<0.001),DKA组HbA1c>7.3%,SHG组HbA1c<6.5%。FINS、FCP及IRI在DKA组均显著低于SHG组和对照组(P均<0.001),DKA组FINS<2.6U/L,FCP<0.16μg/L,IRI<2.7(mmol·U/L);SHG组FINS>9.3U/L,FCP>0.9mg/L,IRI>5.3(mmol·U/L)。SHG组对胰岛素无依赖性,而DKA组需依赖胰岛素才能控制血糖。结论HbA1c、FINS、FCP及IRI是鉴别DKA和SHG的简便、良好的指标。DKA组HbA1c显著升高,FINS、FCP及IRI均显著降低;SHG组FINS、FCP及IRI均显著升高,HbA1c<6.5%。且DKA的治疗依赖胰岛素,而SHG组治疗不依赖胰岛素。

Objective To evaluate the differential diagnostic indexes of ketoacidosis （DKA） in newly diagnosed type 1 diabetic and in critically ill stress hyperglycemia （SHG） pediatric patients. Methods Thirty DKA （aged 6.5± 3.6 years） and 20 SHG patients （aged 5.8 ± 3.1 years） were prospectively studied. Glycosylated hemoglobin （HbAlc） , fasting blood glucose （FBG）, carbon dioxide combining power （CO2-CP）, anion gap （AG）, fasting C-peptide （FCP）, fasting insulin （FINS）, insulin resistance index （IRI）, cortisol （COR） and insulin dependence were compared between DKA and SHG groups. 30 healthy children （aged 6.1± 3.4 years） served as controls （C group）. There were no differences in age and gender among groups （P 〉 0.05 ）. Results （1） FBG, AG, and COR were significantly higher, while CO2-CP was lower in both DKA and SHG groups than in group C （P 〈 0.001）. （2） HbAlc was significantly higher in DKA than in SHG and C groups （P〈 0.001） （〉 7.3% in DKA and 〈 6.5% in SHG）. （3） FINS, FCP, and IRI were significantly lower in group DKA than in SHG and C groups （P 〈 0.001 ） （FINS 〈 2.6 U/L, FCP 〈 0.16μg/L, IRI 〈 2.7 （retool.U/L） in DKA group. FINS 〉 9.3 U/L, FCP 〉 0.9 μg/L, and IRI 〉 5.3 （mmol·U/L） in SHG group）. （4） Control of blood glucose was independent of insulin injection in SHG group, but was insulin dependent in DKA group. Conclusions HbAlc, FINS, FCP, and IRI were simple and specific differential indexes for differential diagnosis of DKA and SHG. FINS, FCP, and IRI were decreased significantly and HbAlc were elevated significantly in DKA, but FCP, FINS, IRI were increased significantly, and HbAlc was 〈 6.5% in SHG group. Insulin dependence or otherwise was a reconfirming index in the differential diagnosis.