血清淀粉酶、肌酸激酶联合血清炎症因子对2型糖尿病酮症酸中毒继发感染的诊断价值

Diagnostic value of serum amylase,creatine kinase,and their combination with serum inflammatory factors in secondary infection of type 2 diabetic ketoacidosis

目的探讨血清淀粉酶、肌酸激酶联合血清炎症因子对2型糖尿病酮症酸中毒继发感染的诊断价值。方法以112例2型糖尿病酮症酸中毒患者根据是否继发感染分为感染组(n=48例)和未感染组(n=64);收集2组患者入院时的一般资料(年龄、性别、居住地、饮酒史、抽烟史、体重指数是否发生胰腺炎或心肌梗死),检测2组患者入院时的血清淀粉酶、肌酸激酶、血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平,采用多因素Logistic回归分析筛选2型糖尿病酮症酸中毒继发感染的危险因素,绘制血清淀粉酶、肌酸激酶、TNF-α及IL-6联合检测2型糖尿病酮症酸中毒继发感染的受试者工作(ROC)曲线,采用曲线下面积(AUC)评估血清淀粉酶、肌酸激酶联合血清炎症因子对2型糖尿病酮症酸中毒继发感染的诊断价值。结果多因素Logistic回归分析的结果显示,血清淀粉酶、肌酸激酶、TNF-α及IL-6是影响2型糖尿病酮症酸中毒继发感染的独立危险因素(P<0.05);ROC曲线分析结果显示,血清淀粉酶、肌酸激酶、TNF-α及IL-6联合检测的AUC(0.996)高于单个指标AUC[血清淀粉酶(0.870)、肌酸激酶(0.870)、TNF-α(0.833)及IL-6(0.897)],差异有统计学意义(P<0.01),联合检测的灵敏度和特异度为95.80%和96.90%,也优于单个指标检测(P<0.01)。结论血清淀粉酶、肌酸激酶、TNF-α及IL-6等是影响2型糖尿病酮症酸中毒继发感染的独立危险因素,血清淀粉酶、肌酸激酶、TNF-α及IL-6联合检测2型糖尿病酮症酸中毒继发感染的检测效能优于单独指标检测。

Objective To explore the diagnostic value of serum amylase,creatine kinase and their combination with serum inflammatory factors in secondary infection of type 2 diabetic ketoacidosis.Methods Based on the absence or presence of secondary infection,112 patients with type 2 diabetic ketoacidosis were divided into infection(n=48)and non-infection(n=64)groups.General information(age,gender,resident location,drinking history,smoking history,body mass index,whether pancreatitis or myocardial infarction occurred)were recorded.Serum amylase,creatine kinase,and serum inflammatory factors including tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected at the admission.Multivariate Logistic regression analysis was applied to screen the risk factors for secondary infection of type 2 diabetic ketoacidosis.Receiver operating(ROC)curves of serum amylase,creatine kinase,TNF-α,IL-6,and their combination were plotted,respectively.The area under the curve(AUC)was used to evaluate the diagnostic accuracy of serum amylase,creatine kinase,TNF-α,IL-6,and their combination in secondary infection of type 2 diabetic ketoacidosis.Results Multivariate Logistic regression analysis showed that serum amylase,creatine kinase,TNF-αand IL-6 were independent risk factors for secondary infection of type 2 diabetic ketoacidosis(P<0.05).ROC curve analysis revealed that AUC of their combination was 0.996,the highest among serum amylase(0.870),creatine kinase(0.870),TNF-α(0.833),and IL-6(0.897).The difference is statistically significant(P<0.01).The sensitivity and specificity of the combination were 95.80%and 96.90%,which were also higher than those of any single factor(P<0.01).Conclusion Serum amylase,creatine kinase,TNF-α,and IL-6 are independent risk factors for secondary infection of type 2 diabetic ketoacidosis.The diagnosing efficiency of their combination is superior than any single factor in secondary infection of type 2 diabetic ketoacidosis.