246例晚期肿瘤住院患者酮症发生风险因素分析  

The Risk Factors of Ketosis in 246 Inpatients with Advanced Cancer

作　　者：张晓彤 刘汝锋[1] 王悦[1] 杨唯唯 韩厅蓄 高学硕[1] 张燕[2] 王国洪[1] 徐国宾[1] ZHANG Xiaotong;LIU Rufeng;WANG Yue;YANG Weiwei;HAN Tingxu;GAO Xueshuo;ZHANG Yan;WANG Guohong;XU Guobin(Department of Clinical Laboratory,Key Laboratory of Carcinogenesis andTranslational Research,Ministry of Education,Peking University Cancer Hospital and Institute,Beijing 100142,China;Department of Gastrointestinal Cancer Center,Key Laboratory of Carcinogenesis andTranslational Research,Ministry of Education,Peking University Cancer Hospital and Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所检验科,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠中心一病区,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《标记免疫分析与临床》2020年第11期1847-1851,共5页Labeled Immunoassays and Clinical Medicine

基　　金：北京市医院管理局重点医学专业发展计划(编号:ZYLX201701)。

摘　　要：目的观察晚期肿瘤患者酮症发生风险与血糖控制之间的关联性,并比较糖化血红蛋白(HbA1c)和糖化白蛋白(GA)反映平均血糖水平的性能。方法入选246例肿瘤内科住院患者,检测其入选当日清晨空腹血糖、血β-羟丁酸(D3-HB)及其他一般生化指标。以D3-HB>0.35 mmol/L为血酮体阳性切值。采用Logistic回归分析酮症发生的危险因素。Pearson相关性分析法比较HbA1c和GA反映患者平均血糖的控制性能。结果受试者酮症阳性率为9.75%(24/246)。多因素Logistic回归分析显示,患消化系统肿瘤(OR=4.664,95%CI:1.805~12.046)、高GA水平(OR=3.147,95%CI:1.184~8.366)和性别(OR=2.673,95%CI:1.075~6.646)是晚期肿瘤患者发生酮症的危险因素(P<0.05)。经Pearson相关性分析发现,血糖控制指标异常的晚期肿瘤患者GA反映平均血糖水平(r=0.75)优于HbA1c(r=0.66)。结论晚期消化系统肿瘤、晚期女性肿瘤患者酮症发生风险高,GA较HbA1c可更好地预测酮症的发生和反映血糖的控制状况。Objective To investigate the correlation between glycemic control and ketosis in advanced cancer inpatients,andto compare the performance of glycated hemoglobin(HbA1c)and glycated albumin(GA)to reflect the average blood glucose level.Methods 246 patients were selected for the current study,fasting blood glucose,β-hydroxybutyric acid(D3-HB)and other general biochemical indicators were measured among subjects.D3-HB>0.35mmol/L was defined as the cut-off for ketosis.Logistic regression was conducted to analyze the risk factors of ketosis.HbA1c and GA were compared to reflect the performance of patients′average glycemic control with Pearson correlation analysis.Results The positive rate of ketosis in research subject was 9.75%(24/246).The multivariate logistic regression analysis indicated that digestive system neoplasm(OR=4.664,95%CI:1.805-12.046),high GA level(OR=3.147,95%CI:1.184-8.366)and gender(OR=2.673,95%CI:1.075-6.646)were risk factors for ketosis(P<0.05).The association of GA with average blood glucose was stronger(r=0.75)than the association of HbA1c with average blood glucose(r=0.66)in abnormal glycemic indicators.Conclusion Patients with advanced digestive system neoplasm and female advanced cancer have a high risk of ketosis.Compared with HbA1c,GA can better predict the occurrence of ketosis and reflect the glycemic control.

关 键 词：晚期肿瘤 酮症 糖化白蛋白 糖化血红蛋白 

分 类 号：R73[医药卫生—肿瘤] R587.2[医药卫生—临床医学]