糖尿病酮症酸中毒合并高脂血症、急性胰腺炎8例临床分析

目的:了解糖尿病酮症酸中毒(DKA)合并高脂血症(HL)、急性胰腺炎(AP)的特点,以提高诊治水平。方法:分析我院诊治的8例DKA合并HL、AP的临床资料,总结其特点。结果:除DKA临床特点外,均为中青年,均腹痛,入院均有HL。其中甘油三脂(TG)≥11.3mmol/L7例(6.54～29mmol/L),未服降脂药,治疗后TG均下降(2.12～6.13mmol/L),入院时血淀粉酶(Ams)超正常值3倍2例,入院后3例,尿Ams则分别为2例和4例,3例血和尿Ams一直正常,5例B超正常,8例胰腺CT均有AP改变,治疗以禁食、纠正DKA为基础结合胃肠减压、质子泵抑制剂、6例生长抑素持续静滴。结论:(1)高脂血症可能是DKA并发AP的原因之一。(2)腹痛者,需警惕DKA、AP并存,应常规及动态测定血、尿Ams、TG。(3)TG≥11.3mmol/L者,即使血、尿Ams正常,B超阴性,仍需胰腺CT检查。(4)DKA伴AP时,除诊治DKA外,还应积极治疗AP,早期用生长抑素能缩短治愈时间。(5)胰岛素泵(CSII)治疗DKA者血糖达标、尿酮转阴时间明显缩短。

Clinic ananlysis of 8 cases with diabetic ketoacidosis complicated by hyperlipidemia or acute pancreatitis

Objective： To understand the character of diabetic ketoacidosis （DKA） compliacted with hyperlipidemia （HL） or acute pancreatitis （AP）. Methods： Clinic data of 8 DKA cases with complication of HL or AP were analyzed and were clinic characters summerized. Results： Besides clinic features of DKA, all cases were young or middle aged patients with abdominal pain and HL. 7 cases had three acids glyeeride （TG） 911.3 mmol/L without using lipid-lowering agent, and the TG level decreased after treatment （ 2.12-6.13 mmol/L）. The blood amylase （Ams） level and urine Ams of 2 cases were 3 times of normal level at admission,in blood Ams 3 cases＇ and in urine Ams 4 cases＇ were abnormal after admission. 3 cases had normal level of both blood Ams and urine Ams, and 5 cases had normal B utrasound imaging. Pancrea CT of 8 cases showed variation indicating AP. These 8 cases were treated with fasting, correcting DKA therapy, gastrointestinal decompression and proton pump inhibitor, 6 of whom had continuous intravenous drip with somatostatin. Conclusion： HP maybe one cause for DKA complicated with AP. For patients with abdominal pain, conventional dynamic test of blood Ams, urine Ams and TG should be employed to determine the complication occurrence of DKA and AP. Pancrea CT is necessary for patients with TG level of more than 11.3 mmol/L even if they had normal blood Ams, urine Ams and negative B ultrasound imaging. For patients with DKA and AP, treatment of AP should be applied besides therapy for DKA. Application of somatostatin can shorten the treatment time, and insulin pump （CSII） can promote the blood sugar to be normal and urine ketone to be negative.