以胃肠道症状为首发症状的DKA伴血淀粉酶升高病例的回顾性分析

Retrospective analysis of diabetic ketoacidosis with the increase of serum amylase in patients with gastrointestinal symptoms as initial symptom

目的回顾性分析以胃肠道症状为首发症状的糖尿病酮症酸中毒(DKA)患者血淀粉酶(AMY)等生化指标以及胰腺影像学特点。方法选北京友谊医院急诊科2012年7月至2015年7月收治的以胃肠道症状为首发症状的DKA患者110例,分为两组,其中高AMY组41例,正常AMY组69例。两组患者均于入院时,完善血WBC计数、血AMY、尿常规、随机血糖、总胆固醇、甘油三酯、血清CO_2、动脉血气p H值及胰腺影像学等检查。将检查结果进行比较。结果高AMY组血AMY、血清二氧化碳以及血脂水平、乃至血WBC计数均明显的区别于正常AMY组(P<0.05),差异具有统计学意义;高AMY组临床症状缓解时间长于正常AMY组,差异具有统计学意义(P<0.05)。结论以胃肠道症状为首发症状的DKA患者应常规检查血淀粉酶;血淀粉酶明显升高的DKA患者,则需要完善胰腺的影像学检查,以避免急性胰腺炎的漏诊。治疗上,需要应用生长抑制素,抑制胰酶的分泌,对改善患者的预后有重要作用。

Objective Retrospectively to analysis biochemical parameters as well as pancreatic imaging features of DKA patients with gastrointestinalsymptoms as the first symptom. Methods 110 cases of diabetic ketoacidosis （DKA） patients with gastrointestinal symptoms as thefirst symptom in emergency department of Beijing friendship hospital between July 2012 to July 2015 were divided into two groups, 41 cases of thehigh AMY group, 69 cases of the normal AMY group. Blood WBC count, serum AMY, urine routine, blood glucose, total cholesterol, triglyceride, serum C02 and arterial blood gas pH value, and pancreatic imaging examination were performed of two groups of patients on admission, andthe results of the examination were compared. Results Blood AMY, serum carbon dioxide, blood lipid levels, and blood WBC count in highAMY group were significantly higher than those of normal AMY group （ P 〈0. 05） , with statistical significance . The remission time of clinicalsymptoms in high AMY group was higher than that in normal AMY group, and the difference was statistically significant （ P 〈0. 05）. ConclusionThe blood amylase should be texted in DKA ptients with gastrointestinal symptoms as the first symptom ; DKA patients with the serum amylasesignificantly increased should be routinely checked with pancreatic imaging examination, in order to avoid misdiagnosis of acute pancreatitis. In thetreatment, somatostatin is needed to be applied in order to inhibit the secretion of pancreatic enzyme, and it plays an important role in improvingthe prognosis of the patients.