老年糖尿病酮症酸中毒病人的临床特征及预后分析  

Clinical characteristics and prognosis of patients with diabetic ketoacidosis in the elderly

作　　者：任烨 程海燕 王霞娟 吴文君 REN Ye;CHENG Hai-yan;WANG Xia-juan;WU Wen-jun(Department of Endocrinology,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院内分泌科,江苏省无锡市214023

出　　处：《实用老年医学》2022年第2期168-172,共5页Practical Geriatrics

基　　金：无锡市青年拔尖人才项目(BJ2020005)。

摘　　要：目的探讨老年糖尿病酮症酸中毒(DKA)病人的临床特征及预后。方法回顾性分析2009年1月至2018年12月在南京医科大学附属无锡人民医院住院治疗的年龄≥18岁的DKA病人的临床资料及实验室数据。比较老年组(≥60岁)与中青年组(<60岁)的临床特征及预后的差异。结果339例成人DKA住院病人中,老年组66例(19.5%),中青年组273例(80.5%);老年组初发糖尿病比例(87.9%)高于中青年组(57.9%)(P<0.05);除外无明显诱因,感染及不遵从治疗方案为老年组的主要诱因;相较中青年组,老年组DKA严重程度更轻(Z=-2.736,P=0.006),但更易合并心血管疾病、高渗状态及肺部感染。老年组治疗过程中低血糖的发生率明显高于中青年组,但pH纠正时间短(P<0.05)。2组住院天数差异无统计学意义,但老年组预后较差。结论DKA可为老年糖尿病病人的首发症状。相较于中青年病人,老年病人DKA严重程度较轻,但更易合并多种疾病,低血糖发生率高,远期预后差。因此,对老年DKA病人的诊治需加强对其共病的关注及治疗。Objective To investigate the clinical characteristics and prognosis of dialetic ketoacidosis(DKA)in the elderly.Methods We conducted a retrospective analysis of adult patients with DKA admitted in Wuxi People’s Hospital Affiliated Nanjing Medical University from January 2009 to December 2018.The DKA patients were categorized by age into the young and middle-aged group(younger than 60 years)and the elderly group(60 years and older).The clinical features and prognosis of DKA patients were collected and compared between the two groups.Results During the decade,we observed 66 patients(19.5%)in the elderly group and 273 patients(80.5%)in the young and middle-aged group.The elderly group had a higher incidence rate of onset diabetes(P<0.05).Except for no obvious predisposing cause(34.8%),infections and non-compliance to insulin therapy were the two most frequent precipitating factors of DKA.The DKA severity of patients in the elderly group was lower than that in the young and middle-aged group(Z=-2.736,P=0.006),however,they had higher incidence rate of cardiovascular diseases,hyperosmotic status and pulmonary infection(P<0.05).The incidence rate of hypoglycemia in the elderly group was significantly higher than that in the young and middle-aged group,while the time to correct pH was shorter than that in the young and middle-aged group(P<0.05).The length of hospital stay was similar in both groups,but long-term prognosis in the elderly group was worse.Conclusions DKA is often the presenting symptom of new-onset diabetes in the elderly.The severity of DKA in the elderly is lower than that in young and middle-aged patients.However elderly patients with DKA are more likely to have comorbidities,hypoglycemia and poor long-term prognosis.It’s necessary to pay more attention to diagnosis and treatment of the comorbidities of elderly patients with DKA.

关 键 词：糖尿病酮症酸中毒 老年人 临床特征 预后 

分 类 号：R587[医药卫生—内分泌]