糖尿病酮症酸中毒患者血清脂肪酶、淀粉酶的改变及相关因素分析

Changes and Related Factors Analysis of Serum Lipase and Amylase in Diabetic Ketoacidosis Patients

目的探讨糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者血清脂肪酶(lipase,LPS)、淀粉酶(amylase,AMS)的改变及相关因素分析。方法通过回顾性病例对照研究,选取2型糖尿病(type 2 diabetes mellitus,T2DM)患者196例,按其是否并发DKA分为DKA组(n=96)和非DKA组(n=100),DKA组根据血清LPS和AMS水平分为LPS升高组(n=54)、LPS正常组(n=42)以及AMS升高组(n=38)、AMS正常组(n=58)。收集患者一般资料、实验室检查等资料,通过单因素分析及多因素Logistic回归分析来探讨影响DKA患者血清LPS、AMS升高的因素。结果与非DKA组比较,DKA组患者多伴有消化道症状,组间比较差异具有统计学意义(P<0.05);DKA组患者血尿素、血糖、AMS、LPS、血浆渗透压、低密度脂蛋白胆固醇、糖化血红蛋白、白细胞计数、中性粒细胞绝对值、血沉、C反应蛋白、降钙素原水平、住院天数、治疗费用均高于非DKA组,pH、氧分压、二氧化碳分压低于非DKA组,组间比较差异均有统计学意义(P均<0.05);LPS升高组患者肌酐、血糖、C反应蛋白水平,住院天数、治疗费用高于LPS正常组(P均<0.05),而钙、pH、二氧化碳分压水平低于LPS正常组(P均<0.05);AMS升高组患者肌酐、血糖、血浆渗透压、白细胞计数水平、住院天数、治疗费用高于AMS正常组(P均<0.05),而pH、二氧化碳分压低于AMS正常组(P均<0.05)。多因素Logistic回归分析表明,血糖升高、pH减低、二氧化碳分压减低是DKA患者LPS升高的影响因素(P<0.05);血糖、血浆渗透压升高,pH、二氧化碳分压减低是DKA患者AMS升高的影响因素(P<0.05)。结论DKA患者可出现血清LPS、AMS升高,血糖、pH、二氧化碳分压是DKA患者LPS、AMS升高的影响因素。

Objective To investigate the changes and related factors analysis of serum lipase(LPS)and amylase(AMS)in diabetic ketoacidosis(DKA)patients.Methods A total of 196 type 2 diabetes mellitus(T2DM)patients were selected by retrospective case-control study and divided into the DKA group(n=96)and non-DKA group(n=100)based on whether they had DKA or not;according to serum LPS and AMS levels,DKA group was divided into LPS elevated group(n=54),LPS normal group(n=42),AMS elevated group(n=38)and AMS normal group(n=58).General data of patients,laboratory indicators and others were collected,factors influencing the increase of serum LPS and AMS in patients with DKA were explored by univariate and multivariate Logistic regression analyses.Results Compared with the non-DKA group,patients in the DKA group had more digestive symptoms,and the difference was statistically significant(P<0.05);the levels of blood urea,blood glucose,AMS,LPS,plasma osmolarity,low-density lipoprotein cholesterol,glycated hemoglobin,white blood cell counts,absolute neutrophil count,erythrocyte sedimentation rate,C-reactive protein,procalcitonin level,hospitalization days and treatment costs in the DKA group were all higher than those in the non-DKA group,the levels of pH,oxgen pressure,parital pressure of carbon dioxide in the DKA group were lower than those in the non-DKA group and the differences were statistically significant(all P<0.05);the levels of creatinine,blood glucose and C-reactive protein,hospitalization days and treatment costs in LPS elevated group were higher than those in LPS normal group(all P<0.05),while the levels of calcium,pH and partial pressure of carbon dioxide were lower than those of LPS normal group(all P<0.05);the levels of creatinine,blood glucose,plasma osmotic pressure,white blood cells,hospitalization days and treatment costs in AMS elevated group were higher than those in AMS normal group(all P<0.05),while the pH and partial pressure of carbon dioxide were lower than those in AMS normal group(all P<0.05).Multivariate Logistic regression analysis showed that the increase of blood glucose,the de-crease of pH and the decrease of partial pressure of carbon dioxide were the influencing factors of LPS increasing in DKA patients(P<0.05);the increase of blood glucose and plasma osmotic pressure and the decrease of pH and partial pressure of carbon dioxide were the influencing factors for the increase of AMS in DKA patients(P<0.05).Conclusion The increase of serum LPS and AMS may happen in DKA patients,and blood glucose,pH and partial pressure of carbon dioxide are the influencing factors of increase of LPS and AMS in DKA patients.