糖尿病酮症酸中毒并肝损害临床分析

Changes in Blood Levels of Nitric Oxide, Oxidation and Lipoperoxidation in Patients with Silicosis

目的探讨导致糖尿病酮症（ＤＫ）及酮症酸中毒（ＤＫＡ）患者肝损害的相关因素．方法ＤＫ或ＤＫＡ患者９９例，其中ＡＬＴ及ＡＳＴ均异常升高１１例（Ａ组），单项ＡＬＴ异常升高１３例（Ｂ组），肝功能正常７５例（Ｃ组），对以上各组患者的血二氧化碳结合力（ＣＯ２ＣＰ）、尿素氮（ＢＵＮ）、血糖（ＢＧ）和血浆渗透压（ＯＳＭ）进行了统计分析．结果Ａ，Ｂ两组患者的ＣＯ２ＣＰ明显低于Ｃ组（Ｐ＜００１，ｔ＝６３３和ｔ＝６４３），而ＢＵＮ则明显升高（Ｐ＜００１，ｔ＝３６１，ＡｖｓＣ；Ｐ＜００１，ｔ＝４３５，ＢｖｓＣ），Ａ组的ＢＧ（Ｐ＜００５，ｔ＝２８４）和血浆ＯＳＭ（Ｐ＜００５，ｔ＝３１０）水平也显著高于Ｃ组，而Ｂ组患者的ＢＧ及血浆ＯＳＭ与Ｃ组比较无差异；与Ｂ组相比，Ａ组患者的ＣＯ２ＣＰ明显降低（Ｐ＜００２，ｔ＝２７１），ＢＧ（Ｐ＜００５，ｔ＝２８９）和血浆ＯＳＭ（Ｐ＜００５，ｔ＝２３６）明显升高．此外，Ⅰ型糖尿病患者血清转氨酶异常升高的发生率明显高于Ⅱ型糖尿病患者（Ｐ＜００５，χ２＝４３８）．结论酸中毒和脱水是导致糖尿病酮症及酮症酸中毒患者肝损害的重要因素，酸中毒及脱水程度与肝损害程度相关．

AIM To study the factors causing hepatic damage in patients with diabetic ketoacidosis. METHODS Ninety nine patients with diabetic ketosis or ketoacidosis, including 11 patients with an elevation of serum ALT and AST activity (group A), 13 patients with an elevation of the serum ALT activity (group B) and 75 with normal liver function (group C), were enrolled in this study. The values of the serum carbon dioxide content (CO 2CP), urea nitrogen (BUN), glucose (BG) and the plasma osmolarity (OSM) in the three groups were analysed statistically. RESULTS The values of CO 2CP in groups A and B were lower than those in group C ( P <0 01, t =6 33 and t =6 43), and serum levels of BUN ( P <0 01, t =3 61), BG ( P <0 05, t =2 84) and OSM ( P <0 05, t =3 10) in group A were higher than those in group C. The values of CO 2CP ( P <0 02, t =2 71), BG ( P <0 05, t =2 89) and OSM ( P <0 05, t =2 36) in group A were also statistically different from those in group B. In addition, the incidence of the hepatic injury in type Ⅰ diabetic patients was significantly higher than those in type Ⅱ diabetic patients ( P <0 05, χ 2=4 38). CONCLUSION The acidosis and dehydration play an important role in the mechanism of the hepatic damage in patients with diabetic ketosis and ketoacidosis, the degree of decline in the serum CO 2CP is correlated with the severity of hepatic injury.