末梢血酮与尿酮在糖尿病酮症诊治中的临床应用价值比较

Comparison of the Clinical Significance of Capillary Bloodβ-hydroxybutyrate and Urine Ketone in the Diagnosis and Treatment of Diabetic Ketosis

目的:比较末梢血酮即β-羟丁酸与尿酮在糖尿病酮症诊断和监测方面的临床价值。方法:收集2013年10月至2014年12月我院内分泌科收治的随机末梢血糖>13.9 mmol/L的糖尿病患者161例,根据尿酮是否阳性分为糖尿病酮症患者29人,非糖尿病酮症患者132人。比较患者末梢血酮、尿酮的相关性;通过受试者工作特征曲线(ROC)寻找血酮诊断糖尿病酮症的诊断切点;比较血酮和尿酮对监测治疗反应性的优缺点。结果:糖尿病患者血酮和尿酮水平呈显著正相关,血酮随尿酮增加而增加(r=0.493,P<0.001),而二者与血糖水平均无明显相关性(P=0.358,P=0.133)。以尿酮为糖尿病酮症诊断标准,ROC曲线下面积0.843(CI,0.746-0.939),末梢血酮诊断酮症的界值为0.25 mmol/L。在监测糖尿病酮症患者治疗的过程中,血酮较尿酮达峰更快,转阴更早。结论:血酮与尿酮有较好相关性,末梢血酮检测有良好的敏感性、及时性和精确性,对治疗策略有更好的指导意义,建议临床推广。

Objective： To compare the clinical significance of capillary blood β-hydroxybutyrate and urine ketone in diagnosing and monitoring DK. Methods： 161 cases of hospitalized diabetes patients with a capillary glucose level13.9 mmol/L in endocrinology department of our hospital were collected from October 2013 to December 2014. They included 29 patients with DK and 132 patients without DK according to urine ketone. We analyzed the correlation between blood ketone and urine ketone, established the capillary blood β-hydroxybutyrate threshold for diagnosing DK by using receiver operating characteristic（ROC） and compare their advantages and disadvantages in monitoring the response to treatment. Results： Capillary blood ketone had a positive correlation with urine ketone,and blood ketone increased with the increase of urine ketone（r=0.493, P〈0.001）. But they both had no significant correlation with blood glucose（P=0.358, P=0.133）. When urine ketone was used as the reference test for diagnosis of DK, area under the ROC curves was 0.843（CI, 0.746-0.939）, and the optimal value of capillary blood β-hydroxybutyrate was 0.25 mmol/L. In the course of treatment and monitoring of DK, blood ketone peaked faster and turned to be negative earlier than urine ketone. Conclusions： There is a good correlation between blood ketone and urine ketone. Capillary blood ketone testing has good sensitivity, timeliness and accuracy. It is helpful to rapid and accurate diagnosis of DK and to reduce the occurrence and development of severe diabetic ketoacidosis（DKA）. It could also reduce emergency department assessment, hospitalization and time to recovery from DK or DKA, as well as potentially lower healthcare expenditure. Blood ketone test has instructive significance in therapy and it is worthy of clinical application.