糖尿病酮症酸中毒住院患者的预后因素分析

目的 回顾性分析糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者预后相关因素,以期提高DKA诊治水平及降低病死率.方法 收集本院内分泌科2014年1月至2016年12月收治的DKA住院患者临床资料.根据DKA患者是否存活分为存活组和死亡组,并回顾性分析2组患者基本情况、入院时血常规、肝肾功、电解质、C反应蛋白、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation scoreⅡ,APACHEⅡ)等观察指标及预后情况.结果 共纳入患者70例,其中男性36例,女性34例,年龄(42.63±15.67)岁.经统计分析结果显示,存活组患者GCS评分(14.41±1.42)vs(11.36 ±3.14)]、血磷(0.96±0.47) mg/L vs(0.68 ±0.60) mg/L]明显高于死亡组(P＜0.05,P＜0.01),存活组APACHEⅡ评分(8.58±4.63)vs(15.73±4.38)]、白细胞总数(14.82 ±9.55)×109/L vs(22.80 ±7.67)×109/L]、C反应蛋白(33.67±45.70) mg/L vs(211.39±173.93) mg/L]、肌酐(87.28±43.89) μmol/L vs(136.47±87.50) μmol/L]、尿素氮(8.45 ±5.00) mmol/L vs(14.72 ±9.23) mmol/L]明显低于死亡组(P ＜0.05,P＜0.01).DKA患者GCS评分(OR =0.510,P＜0.05)越低、APACHEⅡ评分(OR=1.300,P＜0.05)及C反应蛋白(OR=1.031,P＜0.05)越高,预后则越差.结论 C反应蛋白、GCS评分、APACHEⅡ评分是DKA患者独立的预后因素.

Prognostic factors in hospitalized patients with diabetic ketoacidosis

Objective To retrospectively analyze the prognostic factors for diabetic ketoacidsis (DKA) in order to improve the diagnosis and treatment and decreased the mortality for DKA.Methods Clinical data of all DKA patients admitted in our department of endocrinology from January 2014 to December 2016 were collected and retrospectively analyzed.The patients were divided into the survival group and dead group.The baseline data,blood routine results,liver and renal functions,electrolyte levels,C-reactive protein (CRP) level,Scores of Glasgow coma scale (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),and prognosis of the DKA patients were analyzed.Results There were totally 70 subjects enrolled,including 36 males and 34 females,at an average age of 42.63 ± 15.67 years.When compared with the dead group,the survival group had significantly higher GCS score (14.41 ± 1.42 vs 11.36 ± 3.14) and serum phosphate (0.96 ± 0.47 vs 0.68 ± 0.60 mg/L),but obviously lower APACHE Ⅱ score (8.58 ±4.63 vs 15.73 ±4.38),white blood cells count (22.80 ±7.67) × 109/L vs (14.82 ±9.55) × 109/L],CRP level (211.39 ± 173.93 vs 33.67 ± 45.70 mg/L),serum creatinine (136.47 ± 87.50 vs 87.28 ±43.89 μmol/L),and urea nitrogen (14.72 ± 9.23 vs 8.45 ± 5.00 mmol/L) (all P ＜ 0.05,P ＜ 0.01).The lower the GCS score was (OR =0.510,P ＜0.05) and the higher APACHE Ⅱ score (OR =1.300,P ＜0.05) and CRP level (OR =1.031,P ＜ 0.05) were,the worse the prognosis was in the DKA patients.Conclusion CRP level,GCS score and APACHE Ⅱ score are independent prognostic factors for DKA patients.