糖尿病酮症酸中毒血淀粉酶升高的相关危险因素分析

Risk factors analysis of diabetic ketoacidosis combined with elevated serum amylase

目的探讨DKA患者血淀粉酶(AMS)升高的临床危险因素。方法选取263例DKA患者为研究对象,根据AMS水平分为正常组(DKA,n=188)和升高组(HAMS,n=75),HAMS组根据有无急性胰腺炎(AP)发生分出HAMS合并AP亚组(HAMS+AP,n=25),检测FPG、TG、AMS等指标。结果 HAMS组AMS升高发生率28.5%,AP发生率9.5%,其TG、FPG、HbA_1c、Na^+、血浆渗透压、BUN、Scr水平均高于DKA组(P<0.05或P<0.01);HAMS+AP亚组TG、FPG、血浆渗透压、BUN、CO_2结合力(CO_2CP)恢复正常时间均高于HAMS组(P<0.05或P<0.01)。相关分析显示,AMS升高与TG、FPG、Na^+、血浆渗透压、BUN均呈正相关(r=0.146、0.133、0.126、0.182、0.192,P<0.05或P<0.01)。Logistic二元回归分析显示,TG升高是DKA患者AMS升高的独立危险因素(OR1.244,P<0.01),是HAMS+AP的独立危险因素(OR 1.211,P<0.05)。结论 TG升高是DKA患者AMS升高的临床相关危险因素,亦是诱发AP的危险因素。本研究为DKA患者早期筛查AP提供了一定的理论依据。

Objective To investigate the clinical risk factors of diabetic ketoacidosis （DKA） combined with elevated serum amylase（AMS）. Methods Totally 263 patients with DKA were enrolled in our study. They were divided into 2 groups according to the level of AMS： DKA with normal AMS （DKA,n=188） ;DKA with elevated AMS（HAMS, n= 75）. HAMS patients then were divided into two subgroups according to the diagnosis with acute pancreatitis （AP） （ HAMS-7 AP, n = 25） and without AP （HAMS, n = 50）. TG, FPG and AMS were measured and analyzed with univariate analysis and multivariate analysis. Results HAMS group patients had a ratio of 28. 5% with elevated AMS and 9.5% with AP. HAMS group had higher FPG, TG, HbA1 c, Na^＋, osmolality, BUN and Scr than DKA group（P〈0.05）. The levels of FPG, TG, osmolality, BUN and the time of CO2 CP recovery in HAMS.7 AP subgroup were all significantly higher than those in HAMS patients without AP （P〈 0.05）. Correlation analysis showed that HAMS was positively correlated with TG, FPG, Na^＋ , Osmolality and BUN（P〈0.05）. Logistic regression analysis showed that hypertriglyceridemia was the independent risk factor of DKA combined with HAMS（OR 1. 244,P〈0.01） ,and was the independent risk factor of DKA combined with AP（OR 1. 211,P〈0.05）. Conclusion Hypertriglyceridemia is the related risk factor of DKA combined with HAMS and AP. This study provides a theoretical basis tO early screen patients with hyperamylasemia in DKA.