1型糖尿病酮症酸中毒合并淀粉酶水平升高的回顾性分析  

Retrospective analysis of type 1 diabetes ketoacidosis with elevated amylase level

作　　者：王倩[1] 孙胜彬 刘金陵 孙嘉悦 李希 罗雁红[1] WANG Qian;SUN Shengbin;LIU Jinling;SUN Jiayue;LI Xi;LUO Yanhong(Department of Endocrine,Chongqing Medical University Affiliated Children′s Hospital/National Children′s Health and Disease Clinical Medical Research Center/Key Laboratory of Child Developmental Diseases Research of the Ministry of Education/National International Science and Technology Cooperation Base for Major Diseases of Child Development/Chongqing Key Laboratory of Metabolism and Inflammatory Diseases in Children,Chongqing 400015,China;Chongqing Medical University Institute of Life Sciences,Chongqing 400015,China)

机构地区：[1]重庆医科大学附属儿童医院内分泌科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿童发育重大疾病国家国际科技合作基地/儿童代谢与炎症性疾病重庆市重点实验室,重庆400015 [2]重庆医科大学生命科学研究院,重庆400015

出　　处：《现代医药卫生》2024年第21期3601-3607,共7页Journal of Modern Medicine & Health

基　　金：国家自然科学基金项目(82011530460)。

摘　　要：目的了解1型糖尿病酮症酸中毒(DKA)合并血或尿淀粉酶水平升高患儿的临床特点,避免过度诊断或漏诊急性胰腺炎(AP)。方法回顾性收集2018年1月至2022年12月重庆医科大学附属儿童医院住院治疗的296例1型DKA患儿资料,最终纳入101例,按血淀粉酶水平分为S-Amy1组(81例)和S-Amy2组(20例),按尿淀粉酶水平分为U-Amy1组(18例)、U-Amy2组(74例)和U-Amy3组(9例)。分析各组性别、年龄、pH值及甘油三酯(TG)、血淀粉酶、尿淀粉酶、尿糖、尿酮水平等临床资料。结果S-Amy1组、S-Amy2组在pH、尿淀粉酶、高脂血症方面比较,差异有统计学意义(P<0.05),在其他临床资料方面比较,差异无统计学意义(P>0.05)。S-Amy2组中,1例确诊AP,1例疑诊AP。U-Amy1组、U-Amy2组、U-Amy3组在TG、血淀粉酶、高脂血症方面比较,差异有统计学意义(P<0.05),在其他临床资料方面比较,差异无统计学意义(P>0.05)。U-Amy2组确诊1例AP,U-Amy3组疑诊1例AP。101例患儿中,20例血淀粉酶水平升高,其中6例升高3倍及以上;9例尿淀粉酶水平升高,其中3例升高3倍及以上。296例患儿中,8例血或尿淀粉酶水平升高3倍及以上或诊断为AP。结论DKA患儿经常出现非特异性血酶或尿淀粉酶水平升高,且升高3倍及以上时,或TG水平升高时应警惕DKA合并AP,并进一步完善腹部CT扫描。Objective To understand the clinical characteristics of children with type 1 diabetes ketoacidosis(DKA)complicated with elevated serum or urine amylase levels,and to avoid over-diagnosis or missed diagnosis of acute pancreatitis(AP).Methods The data of 296 children with type 1 DKA who were hospitalized in Chongqing Medical University Affiliated Children′s Hospital from January 2018 to December 2022 were retrospectively collected.A total of 101 cases were finally included and divided into S-Amy1 group(81 cases)and S-Amy2 group(20 cases)according to the blood amylase levels,and U-Amy1 group(18 cases),U-Amy2 group(74 cases),and U-Amy3 group(9 cases)based on urine amylase levels.The clinical data including gender,age,pH value,triglycerides(TG),blood amylase,urine amylase,urine glucose,and urine ketone levels in each group were analyzed.Results There were statistically significant differences in pH,urinary amylase and hyperlipidemia between S-Amy1 group and S-Amy2 group(P<0.05),while there were no statistically significant differences in other clinical data(P>0.05).In the S-Amy2 group,one case was diagnosed with AP and one case was suspected with AP.There were significant differences in TG,blood amylase and hyperlipidemia between the U-Amy1 group,U-Amy2 group and U-Amy3 group(P<0.05),but there were no significant differences in other clinical data(P>0.05).In the U-Amy2 group,one case was diagnosed with AP and one case of AP was suspected in the U-Amy3 group.Among the 101 children,the level of serum amylase increased in 20 cases,of which six cases increased by three times or more;urinary amylase levels increased in nine cases,of which three cases increased by three times or more.Among the 296 children,eight cases had elevated blood or urine amylase levels of three times or more or were diagnosed as AP.Conclusion Children with DKA often have non-specific elevation of blood or urine amylase levels.When it increases by three times or more or TG levels increase,AP in DKA should be considered,and abdominal CT scan should

关 键 词：1型糖尿病 糖尿病酮症酸中毒 急性胰腺炎 血淀粉酶 尿淀粉酶 

分 类 号：R5[医药卫生—内科学]