比较血清β-羟丁酸和尿酮体在糖尿病酮症诊断中的意义

Comparison of diagnostic value between serum beta-hydroxybutyrate and urine ketone in diagnosis of diabetic ketosis

目的比较血清β-羟丁酸和尿酮体的检测在糖尿病酮症诊断中的一致性、特异性和敏感性。方法 215例糖尿病患者,其中糖尿病非酮症组52例,糖尿病酮症组患者163例,包括单纯酮症患者125例,酮症酸中毒患者38例。同时进行血清β-羟丁酸和尿酮体的检测,并对酮症组患者治疗后复查,直至酮症消失,观察治疗过程中两者的变化情况,共计观察309例次。结果非酮症组有13.5%的患者β-羟丁酸增高;309例次的检测中,共计65次尿酮体与血β-羟丁酸结果不统一,其中非DK组有7例尿酮体为阴性而血β-羟丁酸为阳性。DK组共58例次不统一,其中49例次表现为尿酮体转阴,而血β-羟丁酸仍为阳性,9例次表现为尿酮体为阳性,而血β-羟丁酸为阴性。结论单纯尿酮体检测对糖尿病酮症的诊断有一定漏诊率,血清β-羟丁酸对糖尿病酮症的检测更敏感,更准确。

Objective To compare the specificity and sensitivity of serum beta-hydroxybutyrate versus urine ketone in diagnosing diabetic ketosis Methods In 215 patients with diabetes mellitus （DM）, including 52 patients with non-ketosis diabetics （NKD）, 125 patients with diabetic ketosis （DK） and 38 patients with diabetic ketoacidosis （DKA）, serum beta-hydroxybutyrate （SBH） and urine ketone （UK） were detected at the same time. The levels of SBH and UK were repeatedly tested until ketobodies were disappeared. The total detection times in 215 cases were 309. Results In NKD group, the positive rate of ketosis was higher in SBH detection （13.5%） than in UK detection （0%）（P〈0. 05）. The betahydroxybutyrate value （mmol/L） was higher in diabetic ketoacidosis patients （0. 67 ±0. 56） than in diabetic ketosis patients （0. 38 ±0. 34）（P〈0. 05）. There were differences in ketobody detetion results between SBH and UK tests. There were seven cases in nondiabetic ketosis patients whose urine KET was negative but serum beta-hydroxybutyrate was positive. There were 49 cases in diabetic ketosis patients whose urine KET was negative but serum beta-hydroxyhutyrate was positive, 9 cases serum betahydroxybutyrate was negative but urine KET was positive. Conclusions Serum β hydroxybutyrate is more sensitive and more accurate for detection of ketosis as compared to urine KET in diagnosis of diabetic ketosis.