血清β-羟丁酸在糖尿病酮症/酮症酸中毒中的诊断价值  

The Diagnostic Value of Serum Beta-hydroxybutyrate in Diabetic Ketosis or Diabetic Ketoacidosis

作　　者：杨惠岚[1] 袁高品[2] 邓浩[3] 陈程[3] 彭茜[1] 安振梅[1] 

机构地区：[1]四川大学华西医院内分泌代谢科,成都610041 [2]福建省泉州市儿童医院七病区,泉州362000 [3]四川大学华西医院全科医学科,成都610041

出　　处：《四川大学学报（医学版）》2014年第2期270-273,共4页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅支撑项目(No.2013FZ0011)资助

摘　　要：目的探讨血清β-羟丁酸在糖尿病酮症/酮症酸中毒(DK/DKA)中的意义和诊断价值。方法回顾2011年5月至2013年5月四川大学华西医院内分泌科1 209例糖尿病无酮症患者(DM组),262例患者(DK/DKA组)和480例同时期行体检的健康对照者(正常对照组)的临床资料,采用logistic回归及ROC曲线判断β-羟丁酸的诊断价值。结果 DK/DKA组患者血清β-羟丁酸水平高于DM组和正常对照组(P<0.01),DK/DKA组血清β-羟丁酸较尿酮体更早转阴(P<0.01)。Logistic回归分析发现血清β羟丁酸为DK/DKA的独立危险因素。β-羟丁酸诊断DK/DKA时的ROC曲线下面积为0.975,取诊断临界值为1 mmol/L作为诊断切点,敏感度85.1%,特异度95.3%,阳性预测值80.36%,阴性预测值96.89%;以血清β羟丁酸0.66mmol/L作为筛选切点,敏感度95%,特异性89.2%,阳性预测值66.41%,阴性预测值99.9%。结论以血清β羟丁酸≥1mmol/L诊断DK/DKA有较高诊断准确性,血清β羟丁酸≤0.66mmol/L时可认为糖尿病患者未合并DK/DKA。Objective To determine the diagnostic value of serum beta-hydroxybutyrate （βOHB） in diabetic ketosis or diabetic ketoacidosis. Methods We conducted a retrospective review of clinical data, in West China Hospital from May 2011 to May 2013, of 1 209 patients with non-ketosis diabetics （DM group）, 262 patients with diabetic ketosis or diabetic ketoacidosis （DK/DKA group）, and 480 healthy people undergoing routine medical examinations （normal control group）. Logistic regression analyses and ROC curves were performed in determining the diagnostic value of βOHB for DK/DKA. Results The level of serum 13OHB was much higher in the DK/DKA patients than that of the participants in the DM group and normal control group （P〈0.01）. The serum 13OHB turned negative earlier than urine ketone （P〈0.01） in the DK/DKA patients. The logistic regression analysis indicated that βOHB was one of the independent risk factors for DK/DKA. The βOHB had an area under of 0. 975 in ROC curve, with 1 mmol/L [sensitivity （Sen.） 85. 1%, specificity （Spe.） 95. 3%, positive predictive value （PV＋） 80.36%, negative predictive value （PV-） 96.89%] as a diagnostic point for DK/DKA and 0.66 mmol/L （Sen. 95 %, Spe. 89.2%, PV＋ 66.41%, PV-99.9 %） as a screening point. Conclusion Diabetic patients with a level or higher than 1 mmol/L serum βOHB can accurately predict DK/DKA. Patients with a level or lower than 0.66 mmol/L serum βOHB are unlikely to have DK/DKA.

关 键 词：血清β羟丁酸 尿酮体糖尿病酮症 糖尿病酮症酸中毒Logistic回归 ROC曲线 

分 类 号：R587.2[医药卫生—内分泌]