以腹部不适为首发症状的26例糖尿病酮症酸中毒临床分析

Clinical Cnalysis of 26 Cases of Diabetic Ketoacidosis Who Have Abdominal Discomfort as the First Symptom

目的:探讨以腹部不适为首发症状的糖尿病酮症酸中毒(DKA)患者血淀粉酶等生化指标及胰腺影像学特点,以提高对DKA临床诊疗认识。方法:26例以腹部不适为首发表现的DKA患者根据血淀粉酶水平分为DKA合并高淀粉酶血症组8例和DKA合并正常血淀粉酶组18例。比较两组患者生化及胰腺影像学特点。结果:DKA合并高淀粉酶血症组血淀粉酶、血白细胞、血清二氧化碳与血淀粉酶正常组比较差异有统计学意义(P<0.05),而两组间血脂、随机血糖及HbA1c水平无显著性差异;同时DKA合并高淀粉酶血症患者临床表现重于血淀粉酶正常组,症状缓解时间长于血淀粉酶正常组,差异具有统计学意义。2例患者血淀粉酶高于正常值3倍,其中1例患者影像学示胰尾部少许渗出。结论:以腹部不适为首发症状的DKA患者应常规检查血淀粉酶;血淀粉酶水平升高明显的DKA患者还需进行胰腺影像学检查避免漏诊胰腺炎,治疗上需要抑制胰液分泌,对改善患者预后有重要作用。

Objective：The purpose of this study is to investigate the changes of biochemical markers（including serum amylase）and imaging features of pancreatic in diabetic ketoacidosis（DKA）patients,whom have abdominal discomfort as the first symptom,to improve understanding of the clinical diagnosis and treatment for DKA.Methods：According to serum amylase levels,26 cases of DKA patients whom have abdominal discomfort as the initial presentation are divided into two groups：DKA with hyperamylasemia group（8 cases）and DKA with normal serum amylase group（18cases）.Biochemical and radiological features of pancreas are compared between two groups.Results：Compared with DKA with normal serum amylase group,patients of DKA with hyperamylasemia are statistically significant（P〈0.05）in levels of serum amylase,white blood cells,serum carbon dioxide.However,the two groups have no significant difference in levels of lipids,random blood glucose and HbA1 c.Patients of DKA with hyperamylasemia have much heavier clinical manifestations and take a longer time to relieve than normal serum amylase group,differences are significant.The level of serum amylase in two patients are three times higher than normal and imaging shows that there is a little exudation in pancreatic tail of one patient.Conclusion：DKA patients with abdominal discomfort as the first symptom should be routinely checked serum amylase.If the blood amylase levels increase significantly,imaging of pancreatitis should be taken to avoid misdiagnosis of pancreatitis,the treatment requires inhibition of pancreatic secretion which has an important role in improving the prognosis of patients.