降钙素原对糖尿病酮症酸中毒感染的预测价值及其水平变化研究  

Value of Procalcitonin in Prediction of Infection of Diabetic Ketodcidosis Patients and the Changes of Procalcitonin Level

作　　者：李佳[1] 姜鲜[2] 马红艳[1] 

机构地区：[1]泸州医学院附属医院内分泌科,四川省泸州市646000 [2]泸州医学院附属医院麻醉科,四川省泸州市646000

出　　处：《中国全科医学》2016年第26期3165-3169,共5页Chinese General Practice

摘　　要：目的探讨血浆降钙素原(PCT)对糖尿病酮症酸中毒(DKA)患者感染的预测价值,及其在DKA患者中水平的变化和影响因素。方法选取2014-01-01至2015-06-30在泸州医学院附属医院内分泌科住院的DKA患者100例,根据有无感染将其分为DKA感染组和DKA无感染组,各50例。另选取本院同期住院糖尿病患者30例作为对照组。分别测定3组血糖、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血淀粉酶、尿淀粉酶、血酮、血肌酐(Scr)、血钾、血钠、血乳酸、B型脑钠肽(BNP)、超敏肌钙蛋白T(hs-Tn T)、p H、白细胞计数(WBC)、中性粒细胞分数、PCT水平。结果 3组血糖、Hb A1c、TG、HDL、LDL、ALT、AST、血淀粉酶、尿淀粉酶、血酮、Scr、血钾、血乳酸、BNP、hs-Tn T、p H、WBC、中性粒细胞分数、PCT水平比较,差异均有统计学意义(P<0.05);其中DKA无感染组WBC、中性粒细胞分数、PCT水平均高于对照组(P<0.05);DKA感染组WBC、中性粒细胞分数、PCT水平高于对照组和DKA无感染组(P<0.05)。WBC、中性粒细胞分数、PCT预测DKA发生感染的受试者工作特征(ROC)曲线下面积分别为0.720〔95%CI(0.617,0.823)〕、0.748〔95%CI(0.652,0.843)〕、0.693〔95%CI(0.588,0.798)〕。DKA无感染组患者PCT水平与ALT、AST、血淀粉酶、尿淀粉酶、Scr、血乳酸、WBC呈正相关(rs=0.348、0.326、0.559、0.460、0.477、0.605、0.424,P<0.05),与p H呈负相关(rs=-0.472,P<0.05)。多元线性回归分析结果显示,ALT、血淀粉酶、血乳酸是影响DKA无感染患者PCT水平的因素(P<0.05)。结论血浆PCT对DKA感染的诊断价值有限。即使DKA在无感染的情况下,血浆PCT水平也明显升高,与ALT、血淀粉酶、血乳酸水平的升高密切相关。Objective To explore the value of procalcitonin（ PCT） for predicting infection of diabetic ketodcidosis （ DKA ） patients, and the level and influencing factors of PCT in DKA patients. Methods 100 DKA patients who were admitted to Department of Endocrinology in the Affiliated Hospital of Luzhou Medical College from 1 January 2014 to 30 June 2015,were divided into DKA with infection group（50 cases）and DKA without infection group（50 cases）. And 30 DM patients were selected as control group. Levels of GLU, HbA1c , TC, TG, HDL, LDL, ALT, AST, hemodiastase, urine amylase,blood ketone,Scr,blood potassium,blood sodium,blood lactic acid,BNP,hs-TnT,pH,WBC,neutrophil rate and PCT of three groups were detected. Results There were significant differences in levels of GLU,HbA1c,TG,HDL, LDL,ALT,AST, hemodlastase, urine amylase, blood ketone, Scr, blood potassium, blood lactic acid, BNP, hs-TnT, pH,WBC,neutrophil rate,and PCT among the three groups（P﹤0. 05）. WBC,neutrophil rate and PCT level of patients in DKA without infection group were significantly higher than those in control group（P﹤0. 05）. WBC,neutrophil rate and PCT level of patients in DKA with infection group were significantly higher than those in control group and DKA without infection group （ P﹤0. 05）. WBC,neutrophil rate and PCT level were used to predict infection of DKA patients,the area under the ROC curve was 0. 720〔95% CI（0. 617,0. 823）〕,0. 748〔95% CI（0. 652,0. 843）〕and 0. 693〔95% CI（0. 588,0. 798）〕respectively. Among patients in DKA without infection group,the PCT level was positively correlated with levels of ALT,AST, hemodiastase,urine amylase,Scr,blood lactic acid,and WBC（ rs = 0. 348,0. 326,0. 559,0. 460,0. 477,0. 605, 0. 424,P﹤0. 05）,and was negatively correlated with pH（rs = -0. 472,P﹤0. 05）. According to multiple linear regression analysis results,ALT,hemodiastase and serum lactic acid were the independent contributing factors for PCT among DKA patients without infection group. Concl

关 键 词：糖尿病酮症酸中毒 降钙素原 感染 

分 类 号：R587.22[医药卫生—内分泌]