降钙素原与乳酸水平的监测在糖尿病酮症酸中毒合并感染中的相关分析  

The significance and value of serum procalcitonin and lactic acid in patients of diabetic acidosis with infection

作　　者：吴晓艳[1] 刘军[1] 沈清[1] 孙燕妮[1] WU Xiaoyan LIU Jun SHEN Qing SUN Yanni(Department of Emergency,Putuo Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200062, Chin)

机构地区：[1]上海中医药大学附属普陀医院急诊内科,上海200062

出　　处：《临床急诊杂志》2017年第3期225-228,共4页Journal of Clinical Emergency

摘　　要：目的:对糖尿病酸中毒合并感染患者血清中降钙素原(PCT)和乳酸水平检测的意义及价值进行探讨。方法:搜集2014-02-2016-08于我院急诊内科住院的所有糖尿病酸中毒合并感染的患者60例作为感染组,选取同期糖尿病酸中毒但未合并感染的患者60例作为非感染性对照。检测患者血清中的PCT和乳酸水平,以及酮体、肝肾功能(ALT和AST、Scr和BUN)、血常规[白细胞计数(WBC)、中性粒细胞百分比]。结果:感染组WBC、中性粒细胞百分比、酮体、AST、BUN水平显著高于对照组(P<0.05),感染组患者血清PCT和乳酸水平均显著高于对照组(P<0.05)。血清PCT和乳酸水平的升高是糖尿病酸中毒合并感染最强的风险预测因素,其OR值分别为3.114和2.072(P<0.05)。血清PCT单独对糖尿病酸中毒合并感染诊断的曲线下面积(AUC)为0.875(P=0.001)高于乳酸的AUC为0.759(P=0.003),但是其诊断的敏感性(83.8%)却高于PCT(73.3%),而PCT的特异性(86.7%)却要高于乳酸的诊断特异性(71.7%),PCT与乳酸联合诊断的AUC(0.881,P<0.001)要高于单独指标的诊断,而且其敏感性(88.6%)和特异性(89.4%)也均要高于单独指标的诊断效能。结论:血清PCT联合乳酸对糖尿病酸中毒合并感染的诊断价值要高于二者单独的诊断效能。Objective：To explore the significance and value of serum procaleitonin （PCT） and lactic acid in pa- tients of diabetic acidosis with infection. Method： Sixty patients of diabetic acidosis with infection （as infection group） and 60 patients of diabetic acidosis without infection （as control） from Emergency Medicine Department between February 2014 to August 2016 were collected. Level of PCT, lactic acid, acetone bodies, ALT, AST, Scr, BUN, white blood celt count （WBC）, neutrophilic granulocyte percentage were detected. Result：The level of WBC, neutrophilic granulocyte percentage, acetone bodies, AST, BUN, PCT, and lactic acid was higher in infection group than control （P〈0.05）. Serum PCT and lactic acid were the most robust predictive factor for diabetic acidosis with infection （OR value was 3. 114 and 2. 072 ,P〈0.05）. The alone AUC of PCT for diabetic acidosis with infection was 0. 875 （P= 0. 001）, which was higher than that of lactic acid 0. 759 （P= 0. 003）, but the sensibility （83.8M） was higher than that of PCT （73.3%）,while the specificity of PCT （86.7%） was higher than that of lactic acid （71.7%） ,in addition, the AUC of combined PCT with lactic acid was 0. 881 （P〈0. 001）, and the sensitivity （88.6%） and specificity （89.4%） were higher than that of alone diagnostic efficiency. Conclusion：The diag- nostic value of serum PCT combined with lactic acid for diabetic acidosis with infection is higher than that alone serum PCT and lactic acid.

关 键 词：糖尿病酸中毒 感染 降钙素原 乳酸 诊断效能 

分 类 号：R587.2[医药卫生—内分泌]