糖尿病酮症酸中毒患者发生胃肠道出血的预测因素:一项回顾性的观察研究

Predictors of acute gastrointestinal bleeding in diabetic ketoacidosis:a retrospective observational study in minority population

背景酮症酸中毒(DKA)是糖尿病一种常见的急性并发症,需要积极的药物治疗。我们旨在研究DKA患者急性胃肠道出血(AGIB)和急性上消化道出血(AUGIB)的发生率及其相关危险因素。方法:我们对本中心2010年1月至2015年12月间收治的DKA病例进行回顾性分析,通过电子病历库收集其人口统计学、临床、实验室、内镜及住院资料。根据有无发生胃肠道出血将患者分为两组。结果:共计234例DKA患者纳入研究,其中27例(11.5%)有AGIB的记录。除2例直肠出血和3例隐匿性出血外,22例(9.4%)表现为呕血。AGIB组与非AGIB组患者年龄、性别和种族的分布无显著差异。两组患者电解质水平、阴离子间隙、pH值及糖化血红蛋白HbA1c的差异亦无统计学意义。然而,AGIB组患者初始血糖水平显著高于非AGIB组(738 mg/dL vs 613 mg/dL,P=0.014)。AGIB组患者病死率也有所升高(7.4%vs 4.8%),尽管差异未达到统计学意义。结论:初始高血糖水平会增加DKA患者发生AGIB的风险。我们还注意到发生AGIB的DKA患者病死率增加,尽管这个增加未达到统计学意义。临床上应更加积极地纠正DKA患者的血糖水平以降低AGIB发生率,从而降低住院病死率。

Background:Diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical management.We attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding(AGIB)and acute upper AGIB(AUGIB)in patients with DKA.Methods:We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December 2015.We collected demographic,clinical,laboratory,endoscopy and hospitalization details using an electronicmedical-record database.Patients were divided into two groups based on the occurrence of gastrointestinal bleeding.Results:A total of 234 patients with DKA were admitted during this period,of which 27(11.5%)patients had documented AGIB.The majority of patients had hematemesis(n=22,9.4%)except two had rectal and three had occult bleeding.We did not notice any difference in age,gender and ethnicity distribution between the two groups.There was no difference in the serum levels of electrolytes,anion gap,pH and hemoglobin A1C between the two groups.However,patients with AGIB had significantly higher initial blood glucose levels(738 vs 613 mg/dL,p=0.014).There was also increased mortality(7.4%vs 4.8%)in patients with AGIB,but this did not reach statistical significance.Conclusion:We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with DKA.We also noted increased in-patient mortality in patients with DKA who had AGIB,even though statistically insignificant.More aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB,thereby reducing mortality during hospitalization in patients with DKA.