糖尿病临床研究

　　【摘要】 目的 探讨血β-羟丁酸(β-HBA)和尿酮(UK)在糖尿病酮症(DK)诊断中的应用。 方法 选取随机末梢血糖>13.9 mmol/L的糖尿病患者76例，同时检测静脉血β-HBA和UK。 结果 研究对象DK发生率15.79%， DKA发生率9.21%。FPG与血β-HBA呈正相关(r=0.322，P=0.005)，与UK无相关性(r=0.071，P=0.536)。血β-HBA与UK呈正相关(r=0.572，P=0.000)。在DK或DKA患者中，10.53%患者尿酮(﹣)或(+﹣)，31.58%患者血β-HBA<1.0 mmol/L。当以UK为标准诊断DK时，血β-HBA切点值0.49 mmol/L。 结论 单用UK或血β-HBA诊断DK均可能发生漏诊，联合检测血β-HBA和UK可减少DK漏诊率。血β-HBA≥0.49 mmol/L时可能已存在DK，此时应检测UK以避免漏诊DK。

　　【关键词】血β-羟丁酸;尿酮;糖尿病酮症

　　【Abstract】 Objective To investigate the relationship between blood β-hydroxybutyric acid (β-HBA) and urine ketone (UK) in diabetes patients. Methods 76 patients with BG>13.9 mmol/L were selected, and β-HBA and UK were detected. Results In 76 patients with BG>13.9 mmol/L, the incidence of diabetic ketosis (DK) and DKA were 15.79% and 9.21%, respectively. BG was positively correlated with β-HBA (r=0.322, P=0.005), but not with UK (r=0.071, P=0.536). β-HBA was positively correlated with UK (r=0.572, P=0.000). 10.53% of patients with DK or DKA were with UK (﹣) or (+﹣), whereas 31.58% of those were with β-HBA<1.0 mmol/L. When UK was used as reference test for diagnosis of DK, the optimal value of β-HBA was 0.49 mmol/L. Conclusion Because missed diagnosis of DK may happen if β-HBA or UK is used alone, the co-monitoring of both can reduce the incidence of missed diagnosis of DK. DK may exist when β-HBA≥0.49 mmol/L. In this situation, UK should be tested in order to avoid missed diagnosis of DK.

　　【Key words】 Blood β-hydroxybutyric acid (β-HBA);Urine ketone (UK);Diabetic ketosis (DK)