血淀粉酶升高在糖尿病酮症酸中毒病情评估中的作用  

The role of elevated blood amylase in the assessment of diabetic ketoacidosis

作　　者：高艳霞[1] 王亚男 袁丁[1] 王艺博 李毅[2] 侯林林 孙沛 张岩[1] 段国宇[1] 徐志高[1] Gao Yanxia;Wang Yanan;Yuan Ding;Wang Yibo;Li Yi;Hou Linlin;Sun Pei;Zhang Yan;Duan Guoyu;Xu Zhigao(Emergency Department,Zhengzhou University First Affiliated Hospital,Zhengzhou 450052,China;Emergency Department,Chinese Academy of Medical Science,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]郑州大学第一附属医院郑东院区急救中心,450052 [2]中国医学科学院北京协和医院急诊科,100730

出　　处：《中华急诊医学杂志》2020年第5期707-710,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨血淀粉酶升高在糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者病情评估中的作用,以及影响糖尿病酮症酸中毒患者血淀粉酶(amylase,AMS)水平的相关因素。方法选取郑州大学第一附属医院2011年11月至2018年8月收治的DKA患者进行回顾性研究,根据入选和排除标准最终确定249例DKA患者为研究对象,根据入院次日晨空腹抽取静脉血测得的AMS水平分为正常组(n=176)和升高组(n=73)。对性别、糖尿病类型、糖尿病血管并发症、死亡例数、ICU监护例数、出院后发生急性胰腺炎(acute pancreatitis,AP)次数等计数资料采用χ^2检验或Fisher检验,对年龄、pH、糖化血红蛋白(HbA1c)、二氧化碳结合力(CO2CP)、Ca^2+、尿素氮(BUN)、肌酐(Scr)等计量资料采用独立样本t检验,比较两组患者一般资料、临床资料、院内及院外结局的差异。结果AMS升高组ICU监护率为50.7%,ICU监护天数中位数为4 d,总住院天数中位数为14 d,治疗费用中位数为2.8万,均高于AMS正常组(P<0.05);病死率、住院期间合并AP、出院后发生AP的比例在AMS升高组与正常组间差异无统计学意义(P>0.05),糖尿病病程、既往发生DKA次数、糖尿病血管并发症发生率、HbA1c、pH、BUN、Scr,在AMS升高组均高于正常组(P<0.01或P<0.05)。结论AMS升高的DKA患者,需要收入ICU监护病房的可能性增加,在ICU内监护天数、总住院天数及总治疗费用增加,住院期间总体病死率及出院后发生AP的可能性未增加。Objective To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis(DKA)patients and the related factors affecting serum amylase(AMS)levels in patients with diabetic ketoacidosis.Methods A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study.The patients were divided into the normal group(n=176)and the elevated group(n=73)according to the AMS level measured by fasting venous blood samples.The enumeration data such as sex,type of DM,diabetic vascular complications,number of deaths,number of ICU monitoring,and number of acute pancreatitis(AP)after discharge were analyzed by chi-square test or Fisher test,and the measurement data such as age,pH,HbA1c,CO2CP,Ca^2+,BUN,and Scr were analyzed by independent sample t test to compare the difference between the two groups.Results The intensive care unit(ICU)monitoring rate was 50.7%,the median length of stay in ICU was 4 days,the median length of hospital stay was 14 days,and the median treatment cost was 28000 yuan,which were higher in the elevated group than those in the normal group(P<0.05).There were no significant differences in mortality,AP during hospitalization,and the probability of AP after discharge between the elevated group and the normal group(P>0.05).The duration of diabetes,the number of previous DKA,the incidence of diabetic vascular complications,HbA1c,pH,BUN,and Scr in the elevated group were all higher than those in the normal group(P<0.01 or P<0.05).Conclusions DKA patients with elevated AMS are more likely to be admitted to ICU,and the length of stay in ICU,total length of hospital stay and total cost of treatment are all increased.Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.

关 键 词：糖尿病酮症酸中毒 血淀粉酶 ICU监护 住院时间 治疗费用 急性胰腺炎 

分 类 号：R587[医药卫生—内分泌]