血酮快速测定在儿童1型糖尿病家庭自我监测中的应用

Self-Monitoring of Blood Ketone Levels at Home in Children with Type 1 Diabetes

目的观察儿童1型糖尿病家庭生活中酮症发生频率,探讨自我监测血酮的意义。方法采用横断面研究,记录30名患儿在家中应用血糖/血酮仪测定的血糖、血酮及尿酮结果。监测1个月。结果 （1）得到1 263对血糖和血酮值,85%血酮水平在正常范围0~0.2 mmol/L,15%血酮水平≥0.3 mmol/L,其中0.9%≥1.0 mmol/L。（2）空腹及餐后酮症发生率：空腹血酮≥0.3 mmol/L的比例为28.8%（131/455）,餐后2 h为7.2%（59/808）,差异有统计学意义（P〈0.05）。（3）不同血糖水平酮症发生率：血糖水平〈7.0 mmol/L组、7.0~11.0 mmol/L组及≥11.1 mmol/L组分别为3.3%、13.1%、20.6%,3组间差异有统计学意义（P〈0.05）。（4）共得到451对血酮和尿酮值,血酮水平≥0.3 mmol/L而尿酮结果阴性的比例为10.4%（22/211）;血酮正常而尿酮阳性的比例为21.9%（53/242）,53对数值中有39对（73.6%）是早晨空腹时的检测结果。经CMH卡方检验,此两种方法对酮症的检测结果具有相关性（P〈0.05）。结论儿童1型糖尿病在家中经常测定血酮将是监测酮症和避免酮症酸中毒的很好参考指标。

Objective To observe the frequency of ketosis in children with type 1 diabetes mellitus and study the significance of self-monitoring blood ketone.Methods Cross-section survey was used among 30 children patients with type 1 diabetes mellitus,the results of blood sugar,blood ketone and urine ketone self-measured with electrochemical blood sugar/ketone meter were recorded.The monitoring was conducted for one month.Results（1） Among 1 263 paired readings of blood glucose and ketone,85% were normal in blood ketone level（0-0.2 mmol/L）,15% were ≥0.3 mmol/L,and of which 0.9% were ≥1.0 mmol/L.（2） In samples whose fasting blood ketone was ≥0.3 mmol/L the prevalence of ketosis was 28.8%（131/455） under fasting conditions,but 7.2%（59/808） 2 hours after meal（P0.05）.（3）The prevalence of ketosis in samples whose blood sugar was7.0 mmol/L,7.0-11.0 mmol/L and ≥11.1 mmol/L was 3.3%,13.1%,and 20.6% respectively,with a statistical significance（P0.05）.（4）Among 451 paired readings of blood and urine ketone,the percentage of samples whose blood ketone was≥0.3 mmol/L and urine ketone was negative was 10.4%（22/211）;while the percentage of samples whose blood ketone was normal and urine ketone was positive was 21.9%（53/242）,among the 53 paired readings there 39（73.6%） whose measurement was conduced under the fasting condition in the morning.CMH Chi-square test showed that the results of ketosis assayed by the two methods were statistically correlated（P0.05）.Conclusion Self-monitoring of blood ketone level in children with type 1 diabetes mellitus at home may be an useful measurement for detecting ketosis and avoiding diabetic ketoacidosis.