血降钙素原乳酸比对糖尿病酮症酸中毒患者感染的诊断研究
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摘要
目的探讨血清降钙素原与乳酸的比值对糖尿病酮症酸中毒患者并发感染的诊断效果,为临床诊断、治疗和改善患者预后提供理论依据。方法选择2014年1月-2017年12月医院接受治疗的糖尿病酮症酸中毒患者89例,根据患者发生医院感染情况分为两组,34例糖尿病酮症酸中毒合并感染患者为感染组,55例未发生感染患者为对照组。对两组患者的临床资料:性别、年龄、体质量指数(BMI)、患病时间及糖尿病类型进行统计分析。记录两组患者白细胞计数、C-反应蛋白(CRP)、降钙素原(PCT)和血清降钙素原与血乳酸比等数据。分析各指标在糖尿病酮症酸中毒患者并发感染检测中的敏感度和特异性。结果两组患者性别、年龄、体质量指数(BMI)、病程及糖尿病类型等临床基本资料比较差异无统计学意义,糖尿病酮症酸中毒并发感染患者白细胞计数、CRP、PCT、血乳酸(Lac)表达水平及血清降钙素原与血乳酸的比值分别为(15.51±3.65)×10~9/L、(17.81±4.52)mg/ml、(0.95±0.37)ng/ml、(3.85±1.71)mmol/L、(0.25±0.11)%,均高于对照组(P<0.05);受试者工作ROC曲线分析发现:白细胞计数、CRP、PCT及PCT/Lac在糖尿病酮症酸中毒患者并发感染预测中均具有较高的敏感度,但PCT/Lac检测的敏感度和特异性最高,分别达到了84.46%、87.23%。结论糖尿病酮症酸中毒并发感染患者白细胞计数、CRP、PCT及PCT/Lac指标水平均升高,PCT/Lac预测感染的价值较高。
OBJECTIVE To explore the effect of ratio of serum procalcitonin to lactic acid on diagnosis of infection in patients with diabetic ketoacidosis so as to provide theoretical basis for clinical diagnosis and treatment as well as the improvement of prognosis.METHODS A total of 89 patients with diabetic ketoacidosis who were treated in the hospital from Jan 2014 to Dec 2017 were enrolled in the study and divided into two groups according to the status of nosocomial infection,34 diabetic ketoacidosis patients who were complicated with infection were assigned as the infection group,and 55 patients who were not complicated with infection were set as the control group.The clinical data of the two groups of patients,including genders,age,body mass index(BMI),time of onset and types of diabetes mellitus,were statistically analyzed;the white blood cell counts,C-reactive protein(CRP),procalcitonin(PCT)and ratio of serum PCT to lactic acid were recorded;and the sensitivity and specificity of the above indexes in diagnosis of the infection in the patients with diabetic ketoacidosis were observed.RESULTS There were no significant difference in the baseline clinical data such as gender,age,BMI,course of disease and types of diabetic mellitus between the two groups of patients.The white blood cell counts,CRP level,PCT level,serum lactic acid(Lac)level and ratio of serum PCT to lactic acid of the infection group were respectively(15.51±3.65)×10~9/L,(17.81±4.52)mg/ml,(0.95±0.37)ng/ml,(3.85±1.71)mmol/L and(0.25±0.11)%,significantly higher than those of the control group(P <0.05).The ROC curve analysis showed the sensitivity of the white blood cell counts,CRP,PCT and PCT/Lac was high in diagnosis of the infection in the patients with diabetic ketoacidosis,and the sensitivity and specificity of PCT/Lac were highest,which were 84.46% and 87.23%.CONCLUSION The levels of WBC,CRP,PCT and PCT/Lac of the diabetic ketoacidosis patients complicated with infection are elevated,PCT/Lac has high value in diagnosis of the infection.
OBJECTIVE To explore the effect of ratio of serum procalcitonin to lactic acid on diagnosis of infection in patients with diabetic ketoacidosis so as to provide theoretical basis for clinical diagnosis and treatment as well as the improvement of prognosis.METHODS A total of 89 patients with diabetic ketoacidosis who were treated in the hospital from Jan 2014 to Dec 2017 were enrolled in the study and divided into two groups according to the status of nosocomial infection,34 diabetic ketoacidosis patients who were complicated with infection were assigned as the infection group,and 55 patients who were not complicated with infection were set as the control group.The clinical data of the two groups of patients,including genders,age,body mass index(BMI),time of onset and types of diabetes mellitus,were statistically analyzed;the white blood cell counts,C-reactive protein(CRP),procalcitonin(PCT)and ratio of serum PCT to lactic acid were recorded;and the sensitivity and specificity of the above indexes in diagnosis of the infection in the patients with diabetic ketoacidosis were observed.RESULTS There were no significant difference in the baseline clinical data such as gender,age,BMI,course of disease and types of diabetic mellitus between the two groups of patients.The white blood cell counts,CRP level,PCT level,serum lactic acid(Lac)level and ratio of serum PCT to lactic acid of the infection group were respectively(15.51±3.65)×10~9/L,(17.81±4.52)mg/ml,(0.95±0.37)ng/ml,(3.85±1.71)mmol/L and(0.25±0.11)%,significantly higher than those of the control group(P <0.05).The ROC curve analysis showed the sensitivity of the white blood cell counts,CRP,PCT and PCT/Lac was high in diagnosis of the infection in the patients with diabetic ketoacidosis,and the sensitivity and specificity of PCT/Lac were highest,which were 84.46% and 87.23%.CONCLUSION The levels of WBC,CRP,PCT and PCT/Lac of the diabetic ketoacidosis patients complicated with infection are elevated,PCT/Lac has high value in diagnosis of the infection.
引文
[1]陈建军,陆东权,李强,等.糖尿病患者发生泌尿系统感染影响因素分析及血清PCT与CRP和血WBC水平的变化研究[J].中华医院感染学杂志,2018,28(10):1507-1510.
[2]American Diabetes Association.Hyperglycemic crises in patients with diabetes mellitus[J].Diabetes Care,2001,24(11):1988-1996.
[3]Kamata Y,Takano K,Kishihara E,et al.Distinct clinical characteristics and therapeutic modalities for diabetic ketoacidosis in type 1and type 2diabetes mellitus[J].J Diabetes Complications,2017,31(2):468-472.
[4]Liu WY,Lin SG,Wang LR,et al.Platelet-to-lymphocyte ratio:a novel prognostic factor for prediction of 90-day outcomes in critically ill patients with diabetic ketoacidosis[J].Medicine(Baltimore),2016,95(4):e2596.
[5]Yu Y,Li HJ.Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy[J].Braz JMed Biol Res,2017,50(5):e6021.
[6]李文华,李健,梁洁,等.血浆降钙素原对糖尿病酮症酸中毒患者发生感染的预测效果[J].中华医院感染学杂志,2017,27(11):2488-2490.
[7]Nodzynski T,Lee TC.A rose by any other name:ketoacidosis due to SGLT2inhibitors reveals latent autoimmune diabetes[J].Am J Med,2018,131(1):e1-e3.
[8]Alois CI,Rizzolo D.Diabetic ketoacidosis:heralding type 1diabetes in children[J].JAAPA,2017,30(7):20-23.
[9]刘英其,李春梅,叶晓燕,等.血流感染脓毒症患者炎症因子水平动态变化对病情严重程度及预后的预测分析[J].中华医院感染学杂志,2018,28(10):1459-1462.
[10]von Oettingen JE,Rhodes ET,Wolfsdorf JI.Resolution of ketoacidosis in children with new onset diabetes:evaluation of various definitions[J].Diabetes Res Clin Pract,2018,135:76-84.
[11]Ramachandran V,Vila DM,Cochran JM,et al.Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus[J].Proc(Bayl Univ Med Cent),2018,31(2):189-191.
[12]Masuta P,Johri G,Paul M.SGLT2inhibitors and euglycemic ketoacidosis[J].Am J Ther,2018,25(4):e498-e500.
[13]Fedorovich SV,Voronina PP,Waseem TV.Ketogenic diet versus ketoacidosis:what determines the influence of ketone bodies on neurons[J].Neural Regen Res,2018,13(12):2060-2063.
[14]中华医学会糖尿病分会.关于糖尿病的新诊断标准及分型[J].中国糖尿病杂志,2000,8(1):5-6.
[15]Zhong VW,Juhaeri J,Mayer-Davis EJ.Trends in hospital admission for diabetic ketoacidosis in adults with type 1and type 2diabetes in England,1998-2013:a retrospective cohort study[J].Diabetes Care,2018,41(9):1870-1877.
[16]Xu Y,Bai J,Wang G,et al.Clinical profile of diabetic ketoacidosis in tertiary hospitals in China:a multicentre,clinic-based study[J].Diabet Med,2016,33(2):261-268.
[17]Cheng YC,Huang CH,Lin WR,et al.Clinical outcomes of septic patients with diabetic ketoacidosis between 2004and2013in a tertiary hospital in Taiwan[J].J Microbiol Immunol Infect,2016,49(5):663-671.
[18]Xu W,Wu HF,Ma SG,et al.Correlation between peripheral white blood cell counts and hyperglycemic emergencies[J].Int J Med Sci,2013,10(6):758-765.
[19]Gao L,Liu X,Zhang D,et al.Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT,CRP and IL-6[J].Exp Ther Med,2017,13(6):3479-3483.
[2]American Diabetes Association.Hyperglycemic crises in patients with diabetes mellitus[J].Diabetes Care,2001,24(11):1988-1996.
[3]Kamata Y,Takano K,Kishihara E,et al.Distinct clinical characteristics and therapeutic modalities for diabetic ketoacidosis in type 1and type 2diabetes mellitus[J].J Diabetes Complications,2017,31(2):468-472.
[4]Liu WY,Lin SG,Wang LR,et al.Platelet-to-lymphocyte ratio:a novel prognostic factor for prediction of 90-day outcomes in critically ill patients with diabetic ketoacidosis[J].Medicine(Baltimore),2016,95(4):e2596.
[5]Yu Y,Li HJ.Diagnostic and prognostic value of procalcitonin for early intracranial infection after craniotomy[J].Braz JMed Biol Res,2017,50(5):e6021.
[6]李文华,李健,梁洁,等.血浆降钙素原对糖尿病酮症酸中毒患者发生感染的预测效果[J].中华医院感染学杂志,2017,27(11):2488-2490.
[7]Nodzynski T,Lee TC.A rose by any other name:ketoacidosis due to SGLT2inhibitors reveals latent autoimmune diabetes[J].Am J Med,2018,131(1):e1-e3.
[8]Alois CI,Rizzolo D.Diabetic ketoacidosis:heralding type 1diabetes in children[J].JAAPA,2017,30(7):20-23.
[9]刘英其,李春梅,叶晓燕,等.血流感染脓毒症患者炎症因子水平动态变化对病情严重程度及预后的预测分析[J].中华医院感染学杂志,2018,28(10):1459-1462.
[10]von Oettingen JE,Rhodes ET,Wolfsdorf JI.Resolution of ketoacidosis in children with new onset diabetes:evaluation of various definitions[J].Diabetes Res Clin Pract,2018,135:76-84.
[11]Ramachandran V,Vila DM,Cochran JM,et al.Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus[J].Proc(Bayl Univ Med Cent),2018,31(2):189-191.
[12]Masuta P,Johri G,Paul M.SGLT2inhibitors and euglycemic ketoacidosis[J].Am J Ther,2018,25(4):e498-e500.
[13]Fedorovich SV,Voronina PP,Waseem TV.Ketogenic diet versus ketoacidosis:what determines the influence of ketone bodies on neurons[J].Neural Regen Res,2018,13(12):2060-2063.
[14]中华医学会糖尿病分会.关于糖尿病的新诊断标准及分型[J].中国糖尿病杂志,2000,8(1):5-6.
[15]Zhong VW,Juhaeri J,Mayer-Davis EJ.Trends in hospital admission for diabetic ketoacidosis in adults with type 1and type 2diabetes in England,1998-2013:a retrospective cohort study[J].Diabetes Care,2018,41(9):1870-1877.
[16]Xu Y,Bai J,Wang G,et al.Clinical profile of diabetic ketoacidosis in tertiary hospitals in China:a multicentre,clinic-based study[J].Diabet Med,2016,33(2):261-268.
[17]Cheng YC,Huang CH,Lin WR,et al.Clinical outcomes of septic patients with diabetic ketoacidosis between 2004and2013in a tertiary hospital in Taiwan[J].J Microbiol Immunol Infect,2016,49(5):663-671.
[18]Xu W,Wu HF,Ma SG,et al.Correlation between peripheral white blood cell counts and hyperglycemic emergencies[J].Int J Med Sci,2013,10(6):758-765.
[19]Gao L,Liu X,Zhang D,et al.Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT,CRP and IL-6[J].Exp Ther Med,2017,13(6):3479-3483.