血小板/淋巴比值与糖尿病酮症酸中毒预后的相关性研究

Correlatlon between platelet-to-lymphocyte ratio and the prognosis of diabetes ketoacidosis

目的探讨血小板/淋巴比值(platelet-to-lymphocyte ratio,PLR)与糖尿病酮症酸中毒预后的相关性。方法选取温州医科大学附属第一医院急诊科抢救治疗的糖尿病酮症酸中毒(diabetes ketoacidosis DKA)患者120例,其中经治疗后幸存者为DKA存活组(共86例),经抢救无效死亡者为DKA死亡组(共34例),同时选取2型糖尿病(type 2 diabetes mellitus,T2DM)患者80例为对照组。记录患者一般资料,并抽取静脉血测定血常规、血糖、肝功能、肾功能等,根据血常规结果计算PLR。结果DKA死亡组PLR高于DKA存活组和对照组,多因素Logistic回归分析提示年龄、有无感染诱因、Glasgow昏迷评分、合并其他器官功能障碍、PLR、机械通气和乳酸均是影响DKA预后的因素,其中PLR的OR值为3.075(95%CI1.951~5.142);ROC曲线分析结果提示PLR的AUC为0.821(95%CI0.761~0.882),当PLR评估DKA患者预后的最佳切点值取192.26时,灵敏度为82.40%,特异度为67.60%。结论PLR与DKA的预后密切相关,可作为迅速判断患者预后的一项灵敏指标。

Objective To investigate the relationship between platelet-to-lymphocyte ratio (PLR) and the prognosis of diabetes ketoacidosis (DKA) . Methods 120 patients with DKA were divided into two groups: the DKA survived group (n=86) and the DKA died group (n=34) . 80 patients with type 2 diabetes (T2DM) were also enrolled in our study as the control group. Their clinical and biochemical parameters were determined. PLR was calculated by blood routine examination. Results Patients in the DKA died group had higher PLR than patients in the DKA survived group and the control group. According to logistic regression analysis, age [OR=2.119 (95% CI 1.506-3.994) , P=0.032], infection [OR=2.047 (95% CI 1.421-3.885) , P=0.021], Glasgow coma score [OR=0.523 (95% CI 0.394-0.693) , P=0.011], simultaneous other organ dysfunction[OR=3.642 (95% CI 2.287-5.442) , P=0.006], PLR[OR=3.073 (95% CI 1.951-5.142) , P<0.001], mechanical ventilation [OR=3.846 (95% CI 2.623-5.113) , P<0.001] and lactic acid [OR=2.854 (95% CI 1.514-4.216, P=0.008] were all significantly correlated with the prognosis of DKA. The optimal cutoff value of PLR for predicting the prognosis of DKA was 192.26. Its sensitivity and specificity were 82.40% and 67.60%, respectively. Conclusion PLR can be used as a sensitive indicator to predict the prognosis of DKA.