摘要
目的探讨血清降钙素原(PCT)、乳酸水平在糖尿病酮症酸中毒(DKA)合并感染患者中的变化及临床意义.方法选择2016年6月至2018年6月温岭市中医院收治的DKA患者112例为研究对象,同期抽取在该院体检的35例健康人为对照组.比较各组受试者的白细胞计数(WBC)、酮体、肌酐(Scr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、PCT及乳酸变化情况.结果与对照组比较,未感染组和感染组患者的WBC[(10.26±4.19)×10^9/L比(14.81±3.79)×10^9/L]、酮体[(2.36±0.79)mmol/L比(6.25±1.02)mmol/L]、Scr[(116.51±41.47)μmol/L比(113.15±37.68)μmol/L]、BUN[76.15±17.33)ng/L比(143.64±16.59)ng/L]、ALT[(81.65±22.56)U/L比79.36±25.34)U/L]、AST[(61.38±12.52)U/L比(78.37±11.74)U/L]及PCT[(1.53±0.59)ng/mL比(5.75±1.21)ng/mL]和乳酸[(3.67±0.56)mmol/L比(10.31±2.51)mmol/L]水平均明显升高,差异均有统计学意义(与对照组比较,t=3.706、10.841、13.484、32.826、8.195、8.465、23.546、48.493、13.622、11.715、13.115、21.148、11.979、26.426、34.766、23.538,均P<0.05);与未感染组比较,感染组的WBC[(14.81±3.79)×10^9/L]、酮体[(6.25±1.02)mmol/L]、BUN[(143.64±16.59)ng/L]、AST[(8.37±11.74)U/L]、PCT[(5.75±1.21)ng/mL]及乳酸[(10.31±2.51)mmol/L]水平明显升高(t=5.349、19.230、18.559、6.547、19.225、15.383,均P<0.05).多因素logistic回归分析显示,血清乳酸和PCT水平是DKA患者合并感染的较强因素.ROC分析显示,PCT、乳酸及联合检测的ACU下面积分别为0.849、0.805和0.930,联合检测的灵敏度(90.91%)、特异度(89.47%)均优于单独检测(PCT:78.33%比82.69%,乳酸:70.18%比70.91%)(灵敏度χ2=3.398、7.092,特异度χ2=3.896、0.048,均P<0.05).结论DKA患者的血清PCT和乳酸水平均较健康人明显升高,且感染患者高于未感染患者,两者联合检测在DKA合并感染患者的诊断中具有较高价值.
Objective To investigate the changes and clinical significance of serum procalcitonin ( PCT) and lactate levels in patients with diabetic ketoacidosis (DKA).Methods A total of 112 patients with DKA admitted to Wenling Hospital of Traditional Chinese Medicine from June 2016 to June 2018 were enrolled.Thirty-five healthy controls in our hospital were selected as the control group.White blood cell counts (WBC),ketone bodies,creatinine (Scr),urea nitrogen (BUN),alanine aminotransferase ( ALT),aspartate aminotransferase ( AST),PCT and lactic acid were measured in each group.Results Compared with the control group,the WBC [(10.26 ± 4.19) ×10^+9 /L vs.(14.81 ± 3.79)×109/L],ketone bodies [(2.36 ± 0.79) mmol/L vs.(6.25 ± 1.02)mmol/L],Scr [(116.51 ± 41.47)μmol/L vs.(113.15 ± 37.68) μmol/L],BUN [(76.15 ± 17.33)ng/L vs.(143.64 ± 16.59)ng/L],ALT [(81.65 ± 22.56)U/L vs.(79.36 ± 25.34)U/L],AST [(61.38 ± 12.52) U/L vs.(78.37 ± 11.74) U/L],PCT [(1.53 ± 0. 59) ng/mL vs.( 5. 75 ± 1. 21) ng/mL] and lactic acid [( 3. 67 ± 0. 56 ) mmol/L vs.( 10. 31 ± 2.51)mmol/L] levels in the uninfected group and the infected group were significantly increased,the differences were statistically significant ( t =3.706,10.841,13.484,32.826,8.195,8.465,23.546,48.493,13.622,11.715, 13.115,21.148,11.979,26.426,34.766,23.538,all P <0.05).Compared with the uninfected group,the WBC [(14.81 ± 3.79 ) ×10^+9 /L], ketone body [( 6.25 ± 1.02 ) mmol/L], BUN [(143.64 ± 16. 59 ) ng/L], AST [(8.37 ± 11.74)U/L],PCT [(5.75 ± 1.21) ng/mL] and lactic acid [(10.31 ± 2.51) mmol/L] levels of the infected group were significantly increased (t =5.349,19.230,18.559,6.547,19.225,15.383,all P <0.05). Multivariate logistic regression analysis showed that serum lactate and PCT levels were stronger factors in patients with DKA.The ROC analysis showed that the areas under the ACU of PCT, lactic acid and combined detection were 0.849,0.805 and 0.930,respectively.The sensitivity (90.91%) and specificity (89.47%) of the combined detec-tion were better than the separate tests (PCT:78.33% and 82.69%,lactic acid:70.18% and 70.91%) (sensitivity χ2 =3.398,7.092,specificity χ2 =3.896,0.048,all P<0.05).Conclusion The serum PCT and lactate levels of DKA patients are significantly higher than healthy people, and those in the infected patients are higher than the uninfected patients.The combined detection of these two indicators has higher value in the diagnosis of patients with DKA co-infection.
作者
柯赛赛
Ke Saisai(Department of Internal Medicine Five,Wenling Hospital of Traditional Chinese Medicine,Wenling,Zhejiang 317500, China)
出处
《中国基层医药》
CAS
2019年第14期1741-1745,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
糖尿病酮症酸中毒
降钙素
乳酸
感染
诊断价值
Diabetic ketoacidosis
Calcitonin
Lactic acid
Infection
Diagnostic value
