糖尿病酮症酸中毒病死率的相关因素分析

Related factors of mortality for patients with diabetic ketoacidosis

目的研究糖尿病酮症酸中毒（diabetic ketoacidosis，DKA）病死率的相关因素。方法从2011年1月至2015年12月选取以DKA为主要诊断的住院患者109例为研究对象。其中T1DM39例，T2DM70例。DKA患者平均年龄42（20。45）岁，男性39例，女性70例。死亡组17例，男性6例，女性11例，平均年龄为56（33，62）岁；生存组92例，男性33例，女性59例，平均年龄为41（21-56）岁。对DKA患者的年龄、12h血糖、性别、12h意识障碍、BMI、高钠血症、12h休克、高脂血症、12h胰岛素用量、高钾血症、发热、糖尿病分型、糖尿病家族史、感染及合并基础疾病用量等进行整理和分析，探究其与DKA病死的相关性。结果109例DKA患者中，死亡17例，死亡率为15．6％。死因如下：急性心肌梗死4例，左心功能不全5例，心跳骤停3例．急性肾功能不全3例，脑血管病2例。单因素回归分析结果显示2组年龄、12h血糖、12h意识障碍、12h休克、12h胰岛素用量、感染、合并基础疾病可能为DKA患者预后不良的危险因素。将单因素分析中具有统计学意义的各因素进行多因素Logistic分析显示年龄（OR=2．954。95％CI：3．081～8．261，P=0．002）、12h血糖〈16．7mmo]／L（OR=1．592，95％CI：1．915-4．920，P=0．006）、感染（OR=2．621，95％CI：1．814～3．945，辟0．030）、合并基础疾病（OR=2．913，95％CI：3．014～9．405，P=0．000）是DKA病死率的独立危险因素。结论本研究通过上述指标尽早的对DKA患者进行危险程度分层，合理及有效地改善DKA患者的预后。

Objective To study the factors related to the mortality of diabetic ketoacidosis （DKA）. Methods From Jan. 2011 to Dec. 2015, 109 hospitalized patients with diabetic ketoacidosis were selected as the subjects, which included 39 cases of type 1 diabetes and 70 cases of type 2 diabetes. DKA patients were ag- ing from 20 to 45 years, including 39 males and 70 females, with the average age of 42. The death group had 17 cases, including 6 males and 11 females with the average age of 56. The survival group had 92 cases, including 33 males and 59 females, with the average age of 41. Age, 12 h blood glucose, sex, 12 h disturbance of con- sciousness, BMI, hypernatremia, 12 h shock, hyperlipidemia, 12 h insulin dosage, hyperkalemia, fever, diabetes mellitus, family history of diabetes, infection and the combined use of basic disease were sorted out and analyzed. Results Among the 109 patients with DKA, 17 died and the mortality rate was 15.6%. The causes of deaths in- cluded acute myocardial infarction in 4 cases, left ventricular dysfunction in 5 cases, 3 case of cardiac arrest, a- cute renal insufficiency in 3 case, and cerebrovascular disease in 3 case. Univariate regression analysis showed that age, 12h blood glucose, 12h disturbance of consciousness, 12h shock, 12h insulin dosage, infection, com- bined with underlying diseases may be risk factors for DKA patients with poor prognosis. Multivariate logistic analysis showed that age（OR=2.954, 95% CI： 3.08l-8.261, P=O.O02）, 12 h blood glucose 〈16.7 mmol/L （OR= 1.592,95% CI： 1.915-4.920,P=0.006）, infection （OR=2.621,95% CI： 1.814-3.945,P=0.030）, combined with underlying disease （OR=2.913,95% CI：3.014-9.405 ,P=0.000）were independent risk factors for DKA mortality. Conclusion By stratifying the mortality risk of DKA patients,the prognosis of DKA patients can be improved rationally and effectively.