2型糖尿病酮症酸中毒合并感染患者血清SAA、PCT/Lac比值、CRP/Alb比值与预后的关系研究

Study on the Relationship between Serum SAA,PCT/Lac Ratio,CRP/Alb Ratio and Prognosis in Patients with Type 2 Diabetic Ketoacidosis Complicated with Infection

目的:探讨2型糖尿病酮症酸中毒合并感染患者血清淀粉样蛋白A(SAA)、降钙素原(PCT)/血乳酸(Lac)比值、C反应蛋白(CRP)/白蛋白(Alb)比值与预后的关系。方法:选择2020年2月至2023年5月中国人民解放军东部战区总医院收治的178例2型糖尿病酮症酸中毒合并感染患者,根据入院28 d临床结局将患者分为生存组、死亡组。对比两组血清SAA、PCT/Lac比值、CRP/Alb比值。多因素logistic回归模型分析影响2型糖尿病酮症酸中毒合并感染患者预后的因素,受试者工作特征(ROC)曲线分析血清SAA、PCT/Lac比值、CRP/Alb比值预测2型糖尿病酮症酸中毒合并感染患者预后的价值。结果:入院28 d后,患者死亡31例,死亡率为17.42%。死亡组血清SAA、PCT/Lac比值、CRP/Alb比值比生存组高(P<0.05)。多因素Logistic回归分析发现,2型糖尿病酮症酸中毒病情程度为重度、SAA水平升高、PCT/Lac比值升高、CRP/Alb比值升高是影响2型糖尿病酮症酸中毒伴感染患者预后的危险因素(P<0.05)。ROC曲线分析发现,血清SAA、PCT/Lac比值、CRP/Alb比值及三者联合预测2型糖尿病酮症酸中毒合并感染患者预后的曲线下面积(AUC)分别为0.781、0.704、0.852、0.901。结论:2型糖尿病酮症酸中毒合并感染患者血清SAA、PCT/Lac比值、CRP/Alb比值上升,且是患者预后的危险因素,联合血清SAA、PCT/Lac比值、CRP/Alb比值对2型糖尿病酮症酸中毒合并感染患者预后的预测价值较高。

Objective:To investigate the relationship between serum amyloid A(SAA),procalcitonin(PCT)/blood lactic acid(Lac)ratio,C-reactive protein(CRP)/albumin(Alb)ratio and prognosis in patients with type 2 diabetic ketoacidosis complicated with infection.Methods:178 patients with type 2 diabetic ketoacidosis complicated with infection who were admitted to the General Hospital of Eastern Theater Command of Chinese People's Liberation Army from February 2020 to May 2023 were selected,patients were divided into survival group and death group according to the clinical outcome of 28 d after admission.The serum SAA,PCT/Lac ratio and CRP/Alb ratio were compared between two groups.The factors affecting the prognosis of patients with type 2 diabetic ketoacidosis complicated with infection were analyzed by multivariate logistic regression model,the value of serum SAA,PCT/Lac ratio and CRP/Alb ratio in predicting the prognosis of patients with type 2 diabetic ketoacidosis complicated with infection were analyzed by receiver operating characteristic(ROC)curve.Results:28 d after admission,31 patients died,with a mortality rate of 17.42%.The serum SAA,PCT/Lac ratio and CRP/Alb ratio in death group were higher than those in survival group(P<0.05).Multivariate Logistic regression analysis showed that,the severity of type 2 diabetic ketoacidosis,the increase of SAA level,the increase of PCT/Lac ratio and the increase of CRP/Alb ratio were the risk factors affecting the prognosis of patients with type 2 diabetic ketoacidosis complicated with infection(P<0.05).ROC curve analysis showed that,the area under the curve(AUC)of serum SAA,PCT/Lac ratio,CRP/Alb ratio and their combination in predicting the prognosis of patients with type 2 diabetic ketoacidosis complicated with infection were 0.781,0.704,0.852 and0.901,respectively.Conclusion:Serum SAA,PCT/Lac ratio and CRP/Alb ratio of patients with type 2 diabetic ketoacidosis complicated with infection increased,and they are risk factors for the prognosis of patients.The combination of serum SAA,PCT/Lac ratio and CRP/Alb ratio has a higher predictive value for the prognosis of patients with type 2 diabetic ketoacidosis complicated with infection.