儿童1型糖尿病酮症酸中毒高危因素分析

Risk factors contributing to diabetic ketoacidosis in children with type 1 diabetes mellitus

目的分析儿童1型糖尿病(type 1 diabetes mellitus,T1DM)酮症酸中毒(diabetic ketoacidosis,DKA)的高危因素,为临床预防儿童1型糖尿病DKA的发生提供相关依据。方法收集81例儿童T1DM患者的临床资料,依据是否发生酮症酸中毒,分为DKA组和非DKA组。比较两组患者在合并感染、甘油三酯(TG)、总胆固醇(TC)、果糖胺等方面的差异,并采用二分类Logistic回归分析T1DM患儿发生DKA的危险因素。结果 T1DM患儿DKA的发生率为43.2%(35/81),DKA组果糖胺水平、TG、TC水平均高于非DKA组,差异有统计学意义(P<0.01),DKA组合并感染的发生率高于非DKA组,差异有统计学意义(χ~2=16.657,P<0.01);多因素二分类Logistic回归分析显示合并感染(P<0.01)和TC(P<0.05)水平为发生DKA的危险因素。结论 T1DM患儿发生DKA的高危因素为合并感染和TC水平,故应定期监测血糖血脂水平,控制感染,降低DKA的发生风险。

Objective To identify the risk factors that contribute to the incurrence of diabetic ketoacidosis(DKA) in children with type 1 diabetes mellitus(T1 DM) so as to inform practitioners in practicing clinical prevention of DKA from children with T1 DM. Methods Firstly, the clinical data of 81 children with T1 DM were collected. The subjects were then divided into two groups, namely, DKA group(n=35) and non-DKA group(n=46), in accordance with whether incidence of DKA was found therein. Secondly, the two groups were compared in terms of co-infection, triglyceride(TG), total cholesterol(TC), fructosamine, etc.. Lastly, the risk factors causing DKA in children with T1 DM were analyzed with binary Logistic regression. Results The rate of incidence of DKA in children with T1 DM was 43.2%(35/81). The levels of fructosamine, TG and TC of the DKA group were all higher than those of the non-DKA group.The differences were statistically significant(P<0.01). The rate of incidence of co-infection in the DKA group was higher than that of the non-DKA group. The difference was statistically significant(χ~2=16.657, P<0.01). Multivariate binary Logistic regression analysis showed that co-infection(P<0.01) and TC(P<0.05) were risk factors contributing to DKA. Conclusions The high risk factors causing DKA in children with T1 DM are combined infection and TC level. Therefore, the risk of DKA can be reduced by means of infection control and regular monitoring of levels of blood glucose and lipid of the patients.