HLP合并DKA的临床特征及危险因素分析

目的 探讨高脂血症性胰腺炎(HLP)合并糖尿病酮症酸中毒(DKA)的临床特征及其相关危险因素。方法 回顾性分析2021年1月至2023年2月HLP患者的临床资料,根据有无DKA,分为高脂血症性胰腺炎组(HLP组)及HLP合并DKA组(HLP+DKA组)。比较两组一般临床资料及实验室资料,通过多因素Logistic回归分析HLP合并DKA的危险因素。结果 24例HLP患者同时存在DKA(29.6%)。既往有糖尿病病史的患者更易合并DKA(P<0.001)。与HLP组相比,HLP+DKA组疾病严重程度更高(P=0.028)。实验室检查方面,HLP+DKA组的空腹血糖(P<0.001)、甘油三酯(P=0.001)、总胆固醇(P<0.001)、高密度脂蛋白胆固醇(P=0.005)、糖化血红蛋白(P<0.001)更高。通过多因素Logistic回归分析显示既往糖尿病病史(OR=65.566,95%CI:1.425~3016.721,P=0.032)与糖化血红蛋白升高(OR=2.637,95%CI:1.225~5.678,P=0.013)是HLP合并DKA的独立危险因素。根据受试者工作特征(ROC)曲线,以糖化血红蛋白8.85%为临界值时,预测HLP+DKA的敏感度为91.3%,特异度为78.9%。结论 既往糖尿病病史及糖化血红蛋白升高是HLP+DKA的独立危险因素。合并DKA可加重HLP严重程度,当糖化血红蛋白为8.85%时,对HLP+DKA的预测值最高,在临床工作中需更加重视。

Objective To investigate the clinical features and risk factors of hyperlipidemia pancreatitis(HLP)complicated with diabetic ketoacidosis(DKA).Methods The clinical data of patients with HLP from January 2021 to February 2023 were analyzed retrospectively.According to the presence or absence of DKA,the patients were divided into two groups:hyperlipidemia pancreatitis group(HLP group)and HLP with DKA group(HLP+DKA group).The general clinical data and laboratory data were compared between the two groups.The risk factors of HLP combined with DKA were analyzed by multivariate Logistic regression.Results 24 patients with HLP had DKA(29.6%).Patients with a history of diabetes mellitus were more likely to have DKA(P<0.001).Compared with HLP group,HLP+DKA group had higher disease severity(P=0.028).In laboratory examination,the fasting blood glucose(P<0.001),triglyceride(P=0.001),total cholesterol(P<0.001),high-density lipoprotein cholesterol(P=0.005)and glycated hemoglobin(P<0.001)were higher in HLP+DKA group.Multivariate Logistic regression analysis showed that history of diabetes(OR=65.566,95%CI:1.425~3016.721,P=0.032)and glycated hemoglobin(OR=2.637,95%CI:1.225~5.678,P=0.013)were independent risk factors for DKA in HLP.According to the receiver operating characteristic(ROC)curve,when glycated hemoglobin 8.85%was the critical value,the sensitivity and specificity of predicting HLP+DKA were 91.3%and 78.9%respectively.Conclusion History of diabetes and increased glycated hemoglobin are independent risk factors for HLP+DKA.Combined DKA can aggravate the severity of HLP.When the glycated hemoglobin is 8.85%,the predictive value of HLP+DKA is the highest.