血β-羟丁酸诊断2型糖尿病酮症酸中毒阈值的建立  

Establishment of blood β-hydroxybutyrate threshold for diagnosis of type 2 diabetes ketoacidosis

作　　者：柯培锋[1] 周海涛[1] 万泽民[1] 吴晓宾[1] 林海标[1] 黄宪章[1] 

机构地区：[1]广东省中医院检验科,广东广州510120

出　　处：《南方医科大学学报》2014年第10期1507-1510,共4页Journal of Southern Medical University

基　　金：广东省医学科研基金(A2012221);广东省中医院朝阳人才专项(2011KT642)

摘　　要：目的探索建立血β-羟丁酸(βOHB)诊断2型糖尿病酮症酸中毒(DKA)的阈值及βOHB水平与DKA严重程度的关系。方法对急症科收治的2型糖尿病患者的血βOHB与[HCO3-]进行相关分析,同时利用回归方程计算出[HCO3-]为18.0、15.0、10.0 mmol/L时的βOHB值,并以与[HCO3-]为18.0 mmol/L对应的βOHB值作为DKA诊断的阈值,并结合临床评估其诊断性能。结果血βOHB水平与[HCO3-]浓度具有良好的相关性,R2=0.7023,P<0.001。[HCO3-]为18.0、15.0和10.0 mmol/L时的βOHB值分别为3.0、4.70和7.5 mmol/L,并与DKA病情严重程度相符;结合血糖浓度≥13.9 mmol/L,当血βOHB≥3.0 mmol/L时,诊断DKA的灵敏度为99.0%,特异性为86.0%,总有效性为92.81%。结论血βOHB≥3.0 mmol/L可作为DKA诊断的阈值,并且βOHB可作为DKA病情严重程度的判断指标。Objective To establish of blood beta hydroxybutyrate（βOHB） threshold for diagnosing type 2 diabetes ketoacidosis（DKA） and explore the relationship between βOHB levels and the severity of DKA. Methods Correlation analysis was performed between serum βOHB and [HCO3] in type 2 diabetic patients admitted in the emergency department in the past year. Regression equation was used to calculate the concentration of βOHB corresponding to a [HCO3] level of 18.0, 15, and10.0 mmol/L, and βOHB concentration corresponding to a [HCO3] level of 18.0 mmol/l was used as the DKA diagnostic threshold. Results The serum βOHB level and [HCO3] concentration showed a good correlation（R2=0.7023, P0.001）. βOHB concentrations that corresponded to a [HCO3] level of 18.0, 15, and 10.0 mmol/L were 3.0, 4.70, and 7.5 mmol/L, respectively, in accordance with the severity of DKA. Combined with the blood glucose concentration ≥13.9 mmol/L, a blood βOHB≥3.0mmol/L showed a sensitivity of 99%, specificity of 86%, and total effectiveness of 92.81% for diagnosing DKA. Conclusion A serum βOHB level above 3.0 mmol/L can be used as the diagnostic threshold of DKA. βOHB can serve as an index for assessing the severity of DKA.

关 键 词：Β-羟丁酸 糖尿病酮症酸中毒 阈值 

分 类 号：R587.2[医药卫生—内分泌]