血清β-羟基丁酸和血糖水平检测在糖尿病酮症酸中毒临床诊断中的应用

Serumβ-hydroxybutyric acid and blood glucose levels in clinical diagnosis of diabetic ketoacidosis

目的探讨血清β-羟基丁酸和血糖水平检测在糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)临床诊断中的应用价值。方法纳入2018年9月至2021年3月就诊于中国人民解放军陆军第七十三集团军医院的42例1型糖尿病患者作为研究对象,其中男24例,女18例,年龄(33.10±15.22)岁;选取同时期性别、年龄和体质量与之相匹配的2型糖尿病患者50例[男28例,女22例,年龄(35.24±13.26)岁]和体检结果无明显异常的健康人群50例[男27例,女23例,年龄(34.62±17.18)岁],采用病例对照研究设计方式进行数据分析和处理。采集血液样本进行血清β-羟基丁酸和血糖水平检测,同时记录糖尿病患者DKA发病情况;分析1型糖尿病患者和2型糖尿病患者、DKA患者和非DKA患者血清β-羟基丁酸和血糖水平的差异,同时对糖尿病患者血清β-羟基丁酸与血糖水平的相关性进行分析。结果1型糖尿病组血清β-羟基丁酸和血糖水平分别为5.91(0.61,10.42)mmol/L、24.83(17.37,29.52)mmol/L,2型糖尿病组分别为0.18(0.11,0.93)mmol/L、19.42(11.76,29.33)mmol/L,健康对照组分别为0.12(0.05,0.24)mmol/L、5.28(4.06,6.74)mmol/L。1型糖尿病组血清β-羟基丁酸和血糖水平均高于健康对照组和2型糖尿病组(均P<0.05),2型糖尿病组血清β-羟基丁酸和血糖水平均高于健康对照组(均P<0.05)。在本研究中,42例1型糖尿病患者中共有26例发生了DKA,DKA发病率为61.9%;50例2型糖尿病患者中共有9例发生DKA,DKA发病率为18.0%,1型糖尿病患者DKA发病率高于2型糖尿病患者,差异有统计学意义(χ^(2)=17.436,P<0.001)。经Kruskal-Wallis秩和检验,1型糖尿病和2型糖尿病中DKA患者血清β-羟基丁酸和血糖水平均高于非DKA患者(1型糖尿病:Hβ-羟基丁酸=17.354,P<0.001;H血糖=2.724,P<0.001。2型糖尿病:Hβ-羟基丁酸=15.286,P<0.001;H血糖=2.627,P<0.001);相关性结果显示1型糖尿病和2型糖尿病患者血清β-羟基丁酸水平与血糖水平均存在明显的相关性(t1型=0.740,P1型<0.001,R21型=0.5474;t2型=0.575,P2型<0.001,R22型=0.3306)。结论1型糖尿病患者血清β-羟基丁酸和血糖水平升高幅度、DKA发病率均高于2型糖尿病患者;1型糖尿病和2型糖尿病DKA患者血清β-羟基丁酸和血糖水平均高于非DKA患者;1型糖尿病和2型糖尿病患者血清β-羟基丁酸水平随血糖水平升高而升高。

Objective To explore the clinical value of serumβ-hydroxybutyric acid and blood glucose levels in the diagnosis of diabetic ketoacidosis(DKA).Methods Forty-two patients with type 1 diabetes who were admitted to The 73rd Group Military Hospital of the Chinese People's Liberation Army Ground Force from September 2018 to March 2021 were included as the research objects,including 24males and 18 females,with an age of(33.10±15.22).At the same time,50 patients with type 2 diabetes[28 males and 22 females,(35.24±13.26)years old]and 50 healthy people with no obvious abnormal physical examination results[27 males and 23 females,(34.62±17.18)years old]were selected with matched gender,age,and weight of the patients with type 1 diabetes.Data analysis was carried out in accordance with the design of case-control study.Blood samples were collected for the examination of serumβ-hydroxybutyric acid and blood glucose levels.The incidences of DKA in the type 1 and 2 diabetic patients were recorded.The differences in serumβ-hydroxybutyric acid and blood glucose levels between the patients with type 1 and 2 diabetes and between the DKA patients and the non-DKA patients were analyzed.The correlation between serumβ-hydroxybutyric acid and blood glucose levels in the diabetic patients was analyzed.Results According to Kruskal-Wallis rank sum test,the serumβ-hydroxybutyric acid and blood glucose levels were 5.92(0.61,10.42)mmol/L and 24.83(17.37,29.52)mmol/L in the type 1 diabetes group,were 0.18(0.11,0.93)mmol/L and 19.42(11.76,29.33)mmol/L in the type 2 diabetes group,and were 0.12(0.05,0.24)mmol/L and 5.28(4.06,6.74)mmol/L in the healthy control group.The serumβ-hydroxybutyric acid and blood glucose levels in the type 1 diabetes group were higher than those in the healthy control group and those in the type 2 diabetes group(all P<0.05),and those in the type 2 diabetes group were higher than those in the healthy control group(both P<0.05).1n this study,26 of the 42 patients with type 1 diabetes developed DKA,and the incidence of DKA was 61.9%;9 of the 50 patients with type 2 diabetes developed DKA,and the incidence of DKA was 18.0%.According to the Chi-square test,the incidence of DKA in the patients with type 1 diabetes was higher than that in the patients with type 2 diabetes(χ^(2)=17.436,P<0.001).According to Kruskal-Wallis rank sum test,the serumβ-hydroxybutyric acid and blood glucose levels of the DKA patients with type 1 and 2 diabetes were higher than those of the non-DKA patients(type 1 diabetes:Hβ-hydroxybutyric acid=17.354,P<0.001;Hblood glucose=2.724,P<0.001.type 2 diabetes:Hβ-hydroxybutyric acid=15.286,P<0.001;Hblood glucose=2.627,P<0.001).Correlation results showed that there were significant correlations between serumβ-hydroxybutyric acid levels and blood glucose levels in the patients with type 1 and 2 diabetes(t1=0.740,P1<0.001,R21=0.5474;t2=0.575,P2<0.001,R22=0.3306).Conclusions The increase in serumβ-hydroxybutyric acid and blood glucose levels and the incidence of DKA in type 1 diabetes patients are higher than those in type 2 diabetes patients.The serumβ-hydroxybutyric acid and blood glucose levels of patients with type 1 and 2 diabetes and DKA are higher than those of non-DKA patients.The serumβ-hydroxybutyric acid levels of patients with type 1 and 2 diabetes increase with blood glucose level.