血β-羟丁酸联合尿酮检测在糖尿病酮症诊断中的临床价值

The Clinical Value of Blood β-hydroxybutyric Acid and Urine Ketone in the Diagnosis of Diabetic Ketosis

目的探讨血β-羟丁酸和尿酮在糖尿病酮症诊断中的临床价值.方法选取2012年5月至2014年5月澄迈县人民医院收治的115例糖尿病非酮症患者(NDK组),85例糖尿病酮症患者(DK组)以及105例健康对照者(对照组)为研究对象.检测各组受试人员血β-羟丁酸、尿酮以及血糖水平;对NDK组和DK组患者血β-羟丁酸、尿酮以及血糖水平进行相关性分析;运用ROC曲线预测血β-羟丁酸对糖尿病酮症的最佳阈值.结果 DK组患者血β-羟丁酸水平、β-羟丁酸阳性率、尿酮体阳性率以及血糖水平均显著高于NDK组和NC组,差异具有统计学意义(P<0.01).相关性分析显示,血β-羟丁酸水平与尿酮及血糖均呈正相关(r=0.552,P<0.000;r=0.405,P=0.010).以尿酮阳性为糖尿病酮症诊断的金标准,通过ROC分析得出血β-羟丁酸诊断的曲线下面积为0.839,最佳阈值为0.64 mmol/L,敏感性为81.6%,特异性为89.2%.结论血β-羟丁酸及尿酮检测对糖尿病酮症的早期诊断均具有重要意义,血β-羟丁酸联合尿酮检测可减少糖尿病酮症的漏诊和误诊,血β-羟丁酸诊断糖尿病酮症的最佳阈值为≥0.64 mmol/L.

Objective To investigate the clinical value of blood β-hydroxybutyric acid and urine ketone in the diagnosis of diabetic ketosis. Methods One hundred and fifteen patients with non-ketosis diabetics (NDK group), 85 patients with diabetic ketosis (DK group) and 105 healthy people(control group) were enrolled in Chengmai People's Hospital from May 2012 to May 2014. Blood β-hydroxybutyric acid,urine ketone and blood glucose were detected; the correlation index of blood β-hydroxybutyric acid,urine ketone and blood glucose in NDK group and DK group were analyzed. The receiver operating characteristic curve(ROC) was performed in determining the diagnostic value of blood β-hydroxybutyric acid for diabetic ketosis. Results The level of blood β-hydroxybutyric acid, positive rate of blood β-hydroxybutyric acid, urine ketone and level of blood glucose in DK group were higher than those in NDK group and NC group ( P<0.01) . Blood β-hydroxybutyric acid waspositively correlated with urine ketone and blood glucose (P=0.552, P=0.000;P =0.405, P=0.010) . When urine ketone was used as diagnostic standard, the area under curve of blood β-hydroxybutyric acid was 0.839,the best cutoff value of β-hydroxybutyric acid was 0.64 mmol/L with the sensitivity was 81.6% and specificity was 89.2%. Conclusions Examinations of blood β-hydroxybutyric acid and urine ketone have great significance for the diagnosis of diabetic ketosis. The co-monitoring of blood β-hydroxybutyric acid and urine ketone can reduce the rates of missed diagnosis and misdiagnosis. The best cutoff value of β-hydroxybutyric acid to diagnose diabetic ketosis was 0.64 mmol/L.