糖尿病酮症酸中毒儿童高乳酸血症的危险因素分析  

Analysis of the risk factors for hyperlactatemia in children with diabetic ketoacidosis

作　　者：刘影[1] 陈娟[1] 赵赛[2] LIU Ying;CHEN Juan;ZHAO Sai(Department of Endocrinology,the Affiliated Huai'an First People's Hospital of Nanjing Medical University,Jiangsu,Huai'an 223300,China;Department of Neonatology,the Affiliated Huai'an First People's Hospital of Nanjing Medical University)

机构地区：[1]南京医科大学附属淮安第一医院内分泌科,江苏淮安223300 [2]南京医科大学附属淮安第一医院新生儿科

出　　处：《徐州医科大学学报》2022年第10期748-752,共5页Journal of Xuzhou Medical University

基　　金：国家自然科学基金(82000743)。

摘　　要：目的探讨糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)儿童高乳酸血症的临床危险因素。方法回顾性分析南京医科大学附属淮安第一医院2015年1月至2020年12月收治住院的儿童DKA患者101例,年龄2~15岁,按照疾病严重程度分为轻度、中度和重度;根据血清乳酸水平分为高乳酸组(≥2.0 mmol/L)和非高乳酸组(<2.0 mmol/L)。收集患儿性别、年龄、是否初发糖尿病、收缩压、舒张压等一般指标,检测患儿入院血糖、尿素氮、肌酐、糖化血红蛋白、血pH值、HCO_(3)^(-)、血钠、血钾、乳酸、总胆固醇、甘油三酯、甲状腺功能等临床生化指标。比较不同血清乳酸水平患儿临床生化指标的差异;相关性分析探讨血清乳酸水平与临床生化指标以及DKA疾病严重程度、DKA纠正时间、平均住院费用的相关性。回归分析探讨影响DKA患儿高乳酸血症的危险因素。结果101例DKA患儿中有42例血清乳酸水平升高,血清乳酸平均水平3.12 mmol/L。与非高乳酸组相比,高乳酸组年龄和入院血糖均升高,pH和HCO_(3)^(-)水平降低。高乳酸组初发糖尿病发病率低于非高乳酸组。DKA患者血清乳酸水平与DKA疾病严重程度、年龄、入院血糖、初发糖尿病呈正相关,与pH、HCO_(3)^(-)呈负相关;血清乳酸水平与DKA纠正时间和住院费用无相关性。Logistic回归分析显示入院高血糖和初发糖尿病是DKA患者血清乳酸水平升高的独立危险因素。结论DKA患儿入院时高血糖及初发糖尿病是发生高乳酸血症的独立危险因素。本研究为预防DKA患儿出现高乳酸血症提供了重要的理论依据。Objective To investigate the risk factors of hyperlactatemia in children with diabetic ketoacidosis.Methods A total of 101 children with diabetic ketoacidosis,aged 2-15 years,who were admitted to the Affiliateel Huai′an First People′s Hospital of Nanjing Medical University from January 2015 to December 2020 were enrolled and their clinical data were retrospectively analyzed.According to the severity of disease,they were divided into three groups:a mild group,a moderate group and a severe group.According to serum lactic acid level,they were divided into a high lactic acid group(≥2.0 mmol/L)and a non-high lactic acid group(<2.0 mmol/L).Then,their general information was collected,including sex,age,new-onset diabetes,systolic blood pressure,and diastolic blood pressure.Furthermore,blood glucose,blood urea nitrogen,creatinine,glycosylated hemoglobin,blood pH value,HCO_(3)^(-),serum sodium,serum potassium,lactic acid,total cholesterol,triglyceride,thyroid function and other clinical biochemical indicators after admission were detected.The differences in clinical biochemical indexes were compared between the two lactic acid groups.Correlation analysis was conducted to explore the relationship between serum lactic acid level and clinical biochemical indexes,DKA severity,DKA correction time,and average hospitalization costs.The risk factors for hyperlactatemia in children with DKA were examined by regression analysis.Results Among the 101 DKA children,42 showed elevated serum lactic acid,with an average level of 3.12 mmol/L.The high lactic acid group presented higher age and blood glucose after admission,and lower pH values and HCO_(3)^(-)levels than the non-high lactic acid group.The incidence of new-onset diabetes in the high lactic acid group was lower than that in the non-high lactic acid group.Serum lactic acid level in DKA patients were positively correlated with DKA severity,age,blood glucose after admission,and new-onset diabetes,but negatively correlated with pH value and HCO_(3)^(-),without relationship w

关 键 词：儿童糖尿病酮症酸中毒 酸中毒严重程度 血清乳酸 初发糖尿病 

分 类 号：R587.2[医药卫生—内分泌]