儿童1型糖尿病合并酮症酸中毒患者血脂尿酸水平研究

Blood lipids and uric acid levels in children with type 1 diabetes mellitus complicated with ketoacidosis

目的 探讨儿童1型糖尿病合并酮症酸中毒患者血脂尿酸水平变化情况。方法 选取2017年12月至2020年12月山西省儿童医院内分泌科儿童1型糖尿病合并酮症酸中毒急性期入院治疗且血脂尿酸检查结果完整的69例作为病例组[入院后急性期与恢复期(住院7~10 d后),其中男性33例,女性36例,1~<3岁5例,3~10岁39例,>10~14岁25例],入院时无临床合并症的1型糖尿病51例为对照组(其中男性26例,女性25例,1~<3岁3例,3~10岁29例,>10~14岁19例);依据血气情况病例组分为轻度组(p H<7.3)24例,中度组(p H<7.2)19例,重度组(p H<7.1)26例。回顾性分析、比较各组患者入院与恢复期血脂系列[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、尿酸水平变化规律。病例组急性期予均衡补液、输注胰岛素、纠酸纠酮治疗。结果 病例组急性期[TG(5.3±3.6)mmol/L、TC(5.8±1.7)mmol/L、尿酸(606±237)μmol/L],与对照组相比,差异有统计学意义[TG(1.6±1.0)mmol/L、TC(4.4±1.0)mmol/L、尿酸(338±158)μmol/L](TG:t=-7.358,P<0.01;TC:t=-5.238,P<0.01;尿酸:t=-2.500,P=0.015)。病例组恢复期患者水平[TG(1.5±0.7)mmol/L、TC(4.6±1.0)mmol/L、尿酸(214±125)μmol/L]各指标较急性期显著改变(TG:t=6.638,P<0.01;TC:t=5.366,P<0.01;尿酸:t=7.704,P<0.01)。病例组急性期TG、TC轻度组[(3.3±2.1)mmol/L、(5.2±1.5)mmol/L]、中度组[(6.8±4.6)mmol/L、(6.2±1.9)mmol/L]、重度组[(4.8±2.8)mmol/L、(5.7±1.4)mmol/L]水平均较对照组增高(TG:轻度组t=-2.670,P=0.009,中度组t=-7.771,P<0.01,重度组t=-5.322,P<0.01;TC:轻度组t=-2.427,P=0.017,中度组t=-4.976,P<0.01,重度组t=-3.840,P<0.01);病例组急性期重度组尿酸(569±252)μmol/L,高于对照组(t=-2.931,P=0.005)。结论 儿童1型糖尿病合并酮症酸中毒患者急性紊乱期较对照组会出现血脂系列、尿酸异常,血脂中TG、TC、尿酸水平异常增高;恢复期患者的TG、TC、尿酸水平均较急性期下降,接近正常范围;酸中毒不同程度组TG、TC水平均较对照组增高,重度酸中毒较对照组尿酸异常增高。提示1型糖尿病患儿血脂、尿酸监测有利于病情的评估,更好地指导临床治疗。

Objective To investigate the altered blood lipids and uric acid levels in children with type 1 diabetes mellitus complicated with ketoacidosis.Methods Sixty-nine children with type 1 diabetes mellitus complicated with ketoacidosis(acute phase)admitted to the Department of Endocrinology,Shanxi Provincial Chil-dren′s Hospital between December 2017 and December 2020 and presenting complete test results of blood lipids and uric acid were included as the study group[observed during the acute and convalescent(starting from days 7~10)phases after hospital admission],comprising 33 boys and 36 girls,with 5 aged 1 to<3 years old,39 aged 3 to 10 years old,and 25 aged>10 to 14 years old.Fifty-one children with type 1 diabetes mellitus but without clini-cal complications at admission were included as the control group(including 26 boys and 25 girls,with 3 aged 1 to<3 years old,29 aged 3 to 10 years old,and 19 aged>10 to 14 years old).According to blood gas indexes,the study group was divided into mild group(pH<7.3,n=24),moderate group(pH<7.2,n=19),and severe group(pH<7.1,n=26).The changes in blood lipids[total cholesterol(TC),triglyceride(TG),high density lipoprotein choles-terol(HDL-C),low density lipoprotein cholesterol(LDL-C)]and uric acid levels in each group at admission and during convalescence were retrospectively analyzed and compared.Patients in the acute phase of ketoacidosis were treated with balanced fluid replacement,insulin infusion,and correction for ketosis and acidosis.Results There were statistically significant differences between the study group during the acute phase and con-trol group in TG[(5.3±3.6)mmol/L vs(1.6±1.0)mmol/L,t=-7.358,P<0.01],TC[(5.8±1.7)mmol/L vs(4.4±1.0)mmol/L,t=-5.238,P<0.01]and uric acid[(606±237)μmol/L vs(338±158)μmol/L,t=-2.500,P=0.015]levels.In the study group,the blood lipids and uric acid levels significantly changed during convalescence compared with those dur-ing the acute stage[TG:(1.5±0.7)mmol/L vs(5.3±3.6)mmol/L,t=6.638,P<0.01;TC:(4.6±1.0)mmol/L vs(5.8±1.7)mmol/L,t=5.366,P<0.01;uric acid:(214±125)μmol/L vs(606±237)μmol/L,t=7.704,P<0.01].Com-pared with the control group,both TG and TC levels during the acute phase were elevated in the mild group[TG:(3.3±2.1)mmol/L,t=-2.670,P=0.009 vs controls;TC:(5.2±1.5)mmol/L,t=-2.427,P=0.017 vs controls],mod-erate group[TG:6.8±4.6)mmol/L,t=-7.771,P<0.01 vs controls;TC:(6.2±1.9)mmol/L,t=-4.976,P<0.01 vs con-trols]and severe group[TG:(4.8±2.8)mmol/L,t=-5.322,P<0.01 vs controls;TC:(5.7±1.4)mmol/L,t=-3.840,P<0.01 vs controls].The uric acid level during the acute phase stage in the severe group was higher than that in the control group[(569±252)μmol/L,t=-2.931,P=0.005 vs controls].Conclusion Compared with the control group,children with type 1 diabetes mellitus complicated with acute-phase ketoacidosis show dyslipidemia and hyperuricemia,with abnormal increases in the levels of TG,TC and uric acid.The levels of TG,TC,and uric acid decrease during convalescence and nearly resume to the normal range,compared with those in the acute stage.Compared with the control group,elevation in TG and TC levels is present in children with any severity of ke-toacidosis,while the abnormal increase in uric acid level is seen only in those with severe ketoacidosis.These re-sults suggest that the monitoring of blood lipids and uric acid in children with type 1 diabetes favors the evalua-tion of the disease and may better guide the clinical treatment.