1668例不同类型高血糖危象患者人口学及临床特征分析

Analysis of demographic and clinical characteristics of 1668 patients with different types of hyperglycemic crisis

目的分析比较不同类型高血糖危象患者的人口学特点和临床特征,为防治高血糖危象提供临床依据。方法回顾性收集2015年1月至2020年12月重庆市6家三级综合医院急诊就诊的高血糖危象患者资料,根据不同类型分成糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)、高血糖高渗状态(hyperglycemic hyperosmolar state,HHS)和DKA-HHS三组,采用描述性方法分析各组人口学和临床特征。结果共收集到1668例患者资料,其中DKA组1388例,HHS组113例,DKA-HHS组167例,2型糖尿病占DKA的比例为90.1%。城镇居民医保、农民和退休人员在三组所占的比例较高,≥60岁患者高血糖危象发生率在各年龄段中最高;6年间DKA和HHS的发生率变化较小,而DKA-HHS组显著上升,DKA-HHS组发生休克、意识障碍、住院费用、死亡率均高于其余两组。结论不同类型高血糖危象人口学及临床特征有差异,临床上对于≥60岁,DKA-HHS这一类高血糖危象患者应更加重视。重点加强对高危人群的糖尿病患者进行健康教育与指导,以减少糖尿病高血糖危象的发生。

Objective To analyze and compare the demographic and clinical characteristics of patients with different types of hyperglycemic crisis,so as to provide clinical basis for the prevention and treatment of hyperglycemic crisis.Methods The data of patients with hyperglycemic crisis in six First-level general hospitals in Chongqing from Jan.2015 to Dec.2020 were retrospectively collected and divided into diabetic ketoacidosis(DKA),hyperglycemic hyperosmolar state(HHS)and diabetic ketoacidosis with hyperglycemic hyperosmotic state(DKA-HHS).The demographic and clinical characteristics of each group were analyzed by descriptive method.Results A total of 1668 patients were collected,among whom1388 were DKA,113 were HHS and 167 were DKA-HHS.The proportion of T2DM in DKA was 90.1%,the proportion of urban residents’medical insurance,farmers and retirees was higher in the three groups,and the incidence of hyperglycemic crisis in patients above 60 years old was the highest in all age groups.The incidence of DKA and HHS changed little during the six years,but increased significantly in the DKA-HHS group.Shock,disturbance of consciousness,hospitalization expenses and mortality in the DKA-HHS group were higher than those in the other two groups.Conclusions There are differences in demographic and clinical characteristics among different types of hyperglycemic crisis.Clinically,more attention should be paid to patients above 60 years old and patients with hyperglycemic crisis such as DKA-HHS.Health education and guidance for diabetic patients in high-risk groups should be strengthened in order to reduce the occurrence of diabetic hyperglycemic crisis.