降钙素原乳酸比对糖尿病酮症酸中毒感染的预测价值  

Effects of plasma procalcitonin to lactate ratio for forecasting the incidence of infections in patients with diabetic ketoacidosis

作　　者：黄斌 陈超[1] 杨胜菊[1] 叶山东[1] Huang Bin;Chen Chao;Yang Shengju;Ye Shandong(Department of Endocrinology,Anhui Province Hospital,Hefei 230000,China)

机构地区：[1]安徽省立医院内分泌科,合肥230000

出　　处：《中华糖尿病杂志》2018年第8期548-551,共4页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：安徽省自然科学基金（1508085SMH227）

摘　　要：目的通过检测有或无感染的糖尿病酮症酸中毒（DKA）患者血降钙素原（PCT）／乳酸（Lac）值，评估其在DKA感染的预测价值。方法收集2014年7月至2017年7月在我院内分泌科及急诊内科就诊的DKA患者81例，根据是否感染分为两组，分别记录患者性别、年龄、糖尿病病程、体质指数（BMI），并明确患者糖尿病类型。入院1h内抽取急诊血常规、生化、超敏C反应蛋白（hs-CRP）、PCT并行动脉血气分析，记录白细胞（WBC）、中性粒细胞百分比（N％）、PCT、hs-CRP、Lac、肌酐，计算PCT／Lac值，多因素Logistic分析两组间差异，进一步采用受试者工作特征（ROC）曲线评估各指标对感染的预测价值。结果（1）相较于非感染的DKA患者，感染组在WBC、N％、PCT、Lac以及PCT／Lac显著升高（t=2．183、2．069、2．550、2．144、3．664，均P〈0．05）；（2）Logistic回归分析显示WBC、N％、PCT以及PCT／Lac的增高均可预测DKA合并感染风险增加（B=0．431、0．551、0．442、0．264，95％CI：1．189～1．990、1．076～1．592、1．110～1．483、1．181～1．798，均P〈0．05）；（3）wBc、N％、PCT以及PCT／Lac受试者T作特征曲线下面积分别为：WBC：0．793±0．067、N％：0．715±0．073、PCT：0．804±0．063、PCT／Lac：0．908±0．046，PCT／Lac相较于其他指标具有更佳的预测效能。根据ROC曲线约登指数，PCT／Lac相应的截点值为0．25，其预测灵敏度82．35％，特异度86．49％；（4）分别校正性别、年龄、BMI和WBC、N％、PCT、Lac，PCT／Lac〉0．25仍为DKA合并感染的独立预测指标（OR=10．021、9．498，95％CI：1．665～60．306、1．535～58．747；均P〈0．05）。结论PCT／Lac升高是DKA患者感染的独立相关因素，PCT／Lac〉0．25可作为合并感染的诊断切点。Objective To explore the value of plasma procalcitonin （PCT） to lactate ratio in predicting the infection of patients with diabetic ketoacidosis （DKA）. Methods A prospective cohort study of 81 DKA patients in department of endocrinology or emergency medicine of the hospital were divided into two groups. The infection group （n=30） and non-infection group （n=51）. The following information was obtained from participants＇ records on admission： age, sex, body mass index （BMI）, duration of type 2 diabetes mellitus （T2DM）, and the types of diabetes. All patients were tested for PCT, lactate（Lac）, high sensitive CRP （hsCRP）, white blood cell, neutrophil percentage, PCT/Lac and creatinine within one hour after admission. The difference betneen 2 groups was analyzed by multiple factor Logistic regression analysis. Receiver operating characteristic curve was used to evaluate the predictive value of index to infection. Results （1） There were significant differences of WBC, N%, PCT, Lac and PCT/Lac on admission between two groups （t=2.183, 2.069, 2.550, 2.144, 3.664, all P〈0.05 ）. （2） The related factors were analyzed by logistic regression model, showing that WBC, N%, PCT, and PCT/Lac are still statistical differences between two groups （B=0.431, 0.551, 0.442, 0.264, 95%CI： 1.189-1.990, 1.076-1.592, 1.110-1.483, 1.181-1.798, all P〈0.05）. （3） The area under the receiver operating characteristic curve was 0.793±0.067, 0.715±0.073, 0.804±0.063, 0.908±0.046 respectively according to the level of the WBC, N%, PCT and PCT/Lac. The cutoff point of PCT/Lac was 0.25, the sensitivity and specificity increased up to 82.35% and 86.49%, respectively. Conduslon The higher PCT/Lac ratio is associated with higher infection risk in DKA patients. PCT/Lac equal to 0.25 can be used as a cutoff point.

关 键 词：糖尿病酮症酸中毒 感染 乳酸 预测 降钙素原 

分 类 号：R587.2[医药卫生—内分泌]