糖尿病酮症酸中毒合并新型冠状病毒肺炎的临床特征分析

Analysis of clinical characteristics of diabetic ketoacidosis complicated with coronavirus disease 2019

目的 分析糖尿病酮症酸中毒(DKA)合并新型冠状病毒肺炎(COVID-19)的临床特征。方法 纳入65例DKA患者并分为DKA组29例和DKA合并COVID-19组36例;收集患者的一般资料。检测2组患者的血尿酸、肌酐、白细胞计数、淋巴细胞绝对值、血红蛋白、首诊血糖、糖化血红蛋白(HbA1c)、β-羟丁酸、碳酸氢根(HCO3-)、动脉血pH、空腹血糖(FBG)、餐后2 h血糖(PBG2 h)、空腹C肽、餐后2 h C肽等实验室的指标,计算住院期间血糖达标时胰岛素使用剂量。结果 2组的血压、性别、体质量指数(BMI)、尿酸、肌酐、血红蛋白、FBG、PBG2 h差异无统计学意义。与DKA组比较,DKA合并COVID-19组年龄较大、病程较长,白细胞计数、首诊血糖、β-羟丁酸、CK、CK-MB、HbA1c增高,胰岛素使用量增加,空腹C肽、餐后2 h C肽、PH及淋巴细胞绝对值降低(P<0.05)。结论 DKA合并COVID-19组患者起病时代谢紊乱及感染更重,免疫力和胰岛细胞功能更差,胰岛素使用量更大。

Objective To explore the clinical features of diabetic ketoacidosis(DKA)complicated with COVID-19.Methods DKA patients were divided into two groups,with 29 cases in the DKA group and 36 cases in the DKA+COVID-19 group.The general data of patients were collected.The serum uric acid,creatinine,white blood cell count,lymphocyte count,hemoglobin,blood glucose at first diagnosis,glycosylated hemoglobin A1c(HbA1c),β-hydroxybutyrate,bicarbonate(HCO3-),arterial blood pH,fasting blood glucose(FBG),2 h postprandial blood glucose(PBG2 h),fasting C-peptide,2 h postprandial C-peptide and other laboratory indexes were detected in two groups.The insulin dosage was calculated when blood glucose reached the standard during hospitalization.Results There were no significant differences in blood pressure,gender,body mass index(BMI),uric acid,creatinine,hemoglobin,FBG and PBG2 h between two groups(P>0.05).Compared with the DKA group,patients in the DKA+COVID-19 group were older and had longer course of disease(P<0.05).The white blood cell count,blood glucose at first diagnosis,β-hydroxybutyrate,CK,CK-MB,HbA1c and insulin use were increased,fasting C-peptide,2 h postprandial C-peptide,PH and lymphocyte count were decreased in the DKA+COVID-19 group (P<0.05). Conclusion Patients with DKA combined with COVID-19 have more severe metabolic disorder andinfection at onset, worse immunity, worse islet cell function and higher insulin use.