C反应蛋白/乳酸、淀粉酶水平与糖尿病酮症酸中毒患者病情及继发感染的关系

Relationship between C Reactive Protein/Lactic Acid and Amylase Levels and Disease and Secondary Infection in Patients with Diabetic Ketoacidosis

目的:分析C反应蛋白/乳酸(CRP/LAC)、淀粉酶(AMS)水平对糖尿病酮症酸中毒(DKA)患者病情及继发感染的预测效能。方法:将2021年1月—2023年7月江西省中西医结合医院收治的DKA患者82例纳入观察组,以动脉血气分析结果为“金标准”,将轻、中度DKA患者纳入轻度组(n=67),将重度DKA患者纳入重度组(n=15);以血培养等病原学检查结果为“金标准”,将发生继发感染者纳入感染组(n=35),未发生继发感染者纳入未感染组(n=47);另选取本院同期未并发DKA的糖尿病患者40例作为对照组。回顾性分析观察组与对照组、轻度组与重度组、感染组与未感染组CRP/LAC、AMS水平差异性;用受试者操作特征(ROC)曲线描述上述指标单独或联合应用于DKA患者重度病情及继发感染的预测。结果:观察组CRP/LAC、AMS水平均高于对照组,重度组CRP/LAC、AMS水平均高于轻度组,感染组CRP/LAC、AMS水平均高于未感染组(P<0.05)。CRP/LAC单独预测重度DKA的截断值为20.25,单独预测继发感染的截断值为18.38;AMS水平单独预测重度DKA的截断值为138.65 U/L,单独预测继发感染的截断值为120.55 U/L;两者联合预测重度DKA的曲线下面积(AUC)为0.782[95%CI(0.677,0.866)],敏感度为89.55%,特异度为60.00%,联合预测继发感染的AUC为0.925[95%CI(0.845,0.972)],敏感度为85.11%,特异度为65.71%。结论:不同严重程度、感染情况的DKA患者CRP/LAC、AMS水平差异明显,在入院早期检测上述指标联合预测重度病情及继发感染的效能可靠较高。

Objective:To analyze the predictive efficacy of C reactive protein/lactic acid(CRP/LAC)and amylase(AMS)levels on the disease and secondary infection of patients with diabetic ketoacidosis(DKA).Method:A total of 82 patients with DKA admitted to Jiangxi Integrated Traditional Chinese and Western Medicine Hospital from January 2021 to July 2023 were included in the observation group.Taking the results of arterial blood gas analysis as the"gold standard",patients with mild and moderate DKA were included in the mild group(n=67),and patients with severe DKA were included in the severe group(n=15).Taking the results of blood culture and other etiological tests as the"gold standard",the patients with secondary infected were included in the infected group(n=35),and those without secondary infected were included in the uninfected group(n=47).In addition,40 diabetic patients without DKA were selected as control group in author's hospital during the same period.The differences of CRP/LAC and AMS levels between observation group and control group,mild group and severe group,infected group and uninfected group were retrospectively analyzed.The receiver operating characteristic(ROC)curve is used to describe the prediction of patients with DKA disease severity and secondary infection by using the above indexes alone or in combination.Result:The CRP/LAC and AMS levels in observation group were higher than those in control group,the CRP/LAC and AMS levels in severe group were higher than those in mild group,and the CRP/LAC and AMS levels in infected group were higher than those in uninfected group(P<0.05).The cut-off value of CRP/LAC alone for predicting severe DKA was 20.25,and that for predicting secondary infection alone was 18.38.The cut-off value of AMS levels alone for predicting severe DKA was 138.65 U/L,and that for predicting secondary infection alone was 120.55 U/L.The area under the curve(AUC)of the combined prediction of severe DKA was 0.782[95%CI(0.677,0.866)],the sensitivity was 89.55%,the specificity was 60.00%,and the AUC of the combined prediction of secondary infection was 0.925[95%CI(0.845,0.972)],the sensitivity was 85.11%and the specificity was 65.71%.Conclusion:The CRP/LAC and AMS levels in DKA patients with different severity and infection are obviously different.It is reliable to detect the above indexes in the early stage of admission to predict the disease and secondary infection.