探析β-羟丁酸与尿酮体在小儿糖尿病酮症酸中毒诊断中临床应用价值

目的探讨测定血清β-羟丁酸与尿酮体定性分析在小儿糖尿病酮症酸中毒诊断中临床应用价值。方法抽取该院2012年12月—2014年6月来该院就诊55例小儿I型糖尿病患者,其中糖尿病酮症酸25例(观察1组)、糖尿病非酮症30例(观察2组),正常健康体检者32名(对照组)为研究对象,对其分别进行β-羟丁酸酶法测定及尿酮体化学法定性分析,并对两种结果进行比对。结果观察1组采用尿酮体定性分析阳性仅19例,6例为阴性,阳性率76%;而采用β-羟丁酸酶速率法阳性仅24例,1例为阴性,阳性率96%;两种之间比较差异有统计学意义(P0.05);观察1组与观察2组比较,其β-羟丁酸、空腹血糖(FBG)、糖化血红蛋白(Hb Alc)明显高于观察2组,差异有统计学意义(P0.01);观察1组与对照组比较,其β-羟丁酸、空腹血糖(FBG)、糖化血红蛋白(Hb Alc)明显高于对照组,差异有统计学意义(P0.01),观察2组与对照组比较,其β-羟丁酸、空腹血糖(FBG)、糖化血红蛋白(Hb Alc)明显高于对照组,差异有统计学意义(P0.01)。结论通过对β-羟丁酸参数进行检测,能够尽早对小儿糖尿病酮症酸中毒患儿进行早期诊断,其灵敏度高于传统的尿酮体定性分析,通过对β-羟丁酸参数进行检测可为临床治疗小儿糖尿病酮症酸中毒治疗方案提供可靠依据。     

《血酮监测》

正糖尿病酮症(DK)和糖尿病酮症酸中毒(DKA)是糖尿病常见急性并发症,也是最常见的病理性酮症状态,若诊断治疗不及时可能导致死亡,在DK/DKA早期,乙酰乙酸转化为β-羟丁酸,从而使血β-羟丁酸/乙酰乙酸比值从正常的2-3:1提高到16:1。给予补液及胰岛素治疗,β-羟丁酸/乙酰乙酸比值下降,酮体水平整体下降。血酮体水平是DK和DKA诊断的重要指标之一,血酮体检测贯穿DKA诊断、治疗和预防的整个过程中(附     

血清β-羟丁酸检测在儿童1型糖尿病酮症酸中毒中的应用

儿童糖尿病均是1型糖尿病,有自发糖尿病酮症(DK)及酮症酸中毒(DKA)倾向.以往一般以尿酮体定性、血糖、渗透压、阴离子间隙等指标来指导临床治疗,但严重DKA患儿血中β-羟丁酸等酮体和脂肪酸增高,尿酮体呈弱阳性或阴性,容易掩盖酸中毒,延误诊治.     

《血酮监测》

<正>糖尿病酮症(DK)和糖尿病酮症酸中毒(DKA)是糖尿病常见急性并发症,也是最常见的病理性酮症状态,若诊断治疗不及时可能导致死亡,在DK/DKA早期,乙酰乙酸转化为β-羟丁酸,从而使血β-羟丁酸/乙酰乙酸比值从正常的2-3:1提高到16:1。给予补液及胰岛素治疗,β-羟丁酸/乙酰乙酸比值下降,酮体水平整体下降。血酮体水平是DK和DKA诊断的重要指标之一,血酮体检测贯穿DKA诊断、治疗和预防的整个过程中(附     

酮体检查：β-羟丁酸说了算？

杜女士是一位老“糖友”,一次因天气变化发生了感冒,继而出现了腹部疼痛、恶心等情况。她立即在家里测了尿酮体,结果为弱阳性（介于阴性与阳性之间）,随即她便住进了医院。血酮检查显示她的β-羟丁酸比正常值高出了4倍多,诊断为糖尿病酮症酸中毒。     

血β-羟丁酸和尿酮在糖尿病酮症诊断中的应用

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13.9mmol/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%。血糖与血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≤1.0mmol/L。以UK为标准诊断DK时,血β-HBA切点值0.49mmol/L。结论单用血β-HBA或UK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≥0.49mmol/L时可能已存在DK,此时应检测UK以避免漏诊DK。     

血清β-羟丁酸测定在糖尿病酮症酸中毒中的临床应用价值

目的探讨血清β-羟丁酸测定在糖尿病酮症酸中毒(DKA)中的临床应用价值。方法选取2013-03~2014-03该院住院糖尿病患者127例,其中糖尿病无酮症酸中毒(NDKA组)105例,DKA组22例;另同期选取健康体检人员(正常对照组)120名。采用酶比色法测定三组血清β-羟丁酸和血糖浓度水平,分析其在各组间的差异,并应用受试者工作特征曲线(ROC曲线)进行分析。结果三组β-羟丁酸、血糖浓度水平比较差异有统计学意义(P0.01),DKA组、NDKA组明显高于正常对照组(P0.05),而DKA组又高于NDKA组(P0.05)。血清β-羟丁酸诊断DKA最佳临界值为1.97 mmol/L,敏感度为87.8%,特异度为95.3%,曲线下面积(AUC)为0.947。结论血清β-羟丁酸检测对DKA有较好的准确性,能早期诊断DKA。     

饥饿性酮症

<正>当机体糖脂代谢出现紊乱,脂肪分解加快,酮体(丙酮、乙酰乙酸、β-羟丁酸)生成增多超过机体利用时,血中酮体堆积,即为酮血症;酮体经尿排出时,即为酮尿症。酮症常见于以下几种情况:1、胰岛素依赖型糖尿病患者胰岛素治疗中断或剂量不足,或非胰岛素依赖型糖尿病患者面对各种应激(如创伤、手术、感染等)时;2、肥胖症患者节食或行减重手     

糖尿病急性并发症中肌酸激酶升高患者的临床特征及其临床意义探讨

目的研究糖尿病酮症酸中毒肌酸激酶(CK)升高患者的临床特征及其临床意义。方法选择2014年1月到2015年12月间本院收治的糖尿病酮症酸中毒患者178例,根据是否存在血清CK升高(CK175U/L)分为研究组和对照组。研究组34例(血清CK175U/L),对照组144例(血清CK≤175U/L),比较两组患者血糖、血清电解质、β-羟丁酸和血脂水平,并比例两组合并症发生情况。结果研究组空腹血糖(FBG)、糖化血红蛋白(Hb A1c)和β-羟丁酸均显著高于对照组(P0.05),两组血钾和血钠水平差异无统计学意义(P0.05)。两组患者甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)比较无统计学差异(P0.05)。研究组糖尿病肾病、神经病变和视网膜病变合并率均显著高于对照组(P0.05)。Person相关分析显示,CK升高与β-羟丁酸、Hb A1c、糖尿病肾病和糖尿病视网膜病变呈正相关(P0.05)。结论糖尿病酮症酸中毒CK升高患者较CK正常患者血糖和β-羟丁酸升高更明显,糖尿病肾病、神经病变和视网膜病变合并率更高,病情更重,临床应予以重视。     

检测血β羟丁酸对糖尿病酮症酸中毒的诊断和治疗意义

糖尿病酮症酸中毒 (DKA)临床常以检测尿酮体诊断 ,方法简便易行 ,但是当患者无尿或肾功能严重损坏 ,肾血循环障碍 ,肾小球滤过率减少 ,尿酮可减少或消失时 ,则无法靠尿判断。此外 ,尿酮体试纸仅能与乙酰乙酸起反应 ,与丙酮反应较弱 ,与 β-羟丁酸 (β- HB)无反应 ,当尿中以 β- HB为主时易漏诊 [1 ] ,故查血 β- HB对诊断 DKA是十分必要的。一、材料与方法1.对象 :DKA患者 6 0例 ,男 34例 ,女 2 6例 ,平均年龄(6 1.1± 8.3)岁。非 DKA的 2型糖尿病 6 0例 ,男 33例 ,女 2 7例 ,平均年龄 (6 0 .3± 7.4 )岁。正常组 30例 ,男 17例 ,女…     

Point of care blood ketone testing of diabetic patients in the emergency department

The aim of our study was to determine the utility of point-of-care blood ketone testing in diabetic patients presenting to the emergency department. In this prospective, observational clinical study, patients with known or newly diagnosed diabetes mellitus presenting to our tertiary care university emergency department with any nontrauma related medical complaint and a high fingerstick glucose (> or =200 mg/dL) were eligible for inclusion. Capillary blood beta-hydroxybutyrate (beta-HBA), venous blood beta-HBA level, venous blood glucose level, arterial blood gas analysis, and urine ketone dipstickstick were measured in each patient as primary outcome measures. Of the 479 diabetic patients presenting during the study period, a total of 139 diabetic patients with high capillary blood glucose level (> or =200 mg/dL) and a positive capillary blood beta-HBA (> or =0.1 mmol/L) were included in the study. Hyperketonemia (> or =0.42 mmol/L) was found in 48 of these patients by Sigma Diagnostics reference testing (diabetic ketosis in 35%). The calculated blood pH was less than 7.3 in 18 of these 48 patients (ketoacidosis in 31%). Capillary and venous blood beta-hydroxybutyrate levels were not statistically different from each other (P = 0.824). There was a positive correlation between capillary and venous blood beta-HBA levels (r = 0.488, P < 0.001). The sensitivity and specificity of urine ketone dipstick testing and capillary blood ketone testing in determining diabetic ketoacidosis were 66% and 78%, and 72% and 82%; and in determining hyperketonemia (both in diabetic ketosis and diabetic ketoacidosis) were 82% and 54%, and 91% and 56%, respectively. A rapid, bedside capillary blood ketone test for beta-HBA can accurately measure blood concentrations of beta-HBA in diabetic patients in an emergency department setting. This device can be used as a reliable diagnostic test to detect emergency metabolic problems in diabetic patients, such as diabetic ketosis or ketoacidosis.     

Urine Ketone Dip Test as a Screen for Ketonemia in Diabetic Ketoacidosis and Ketosis in the Emergency Department

Study objective: To determine the sensitivity of the urine ketone dip test (UKDT) for the detection of ketonemia in patients with diabetic ketoacidosis (DKA) and diabetic ketosis (DK) in the ED. Methods: We conducted a retrospective chart review in the ED of an urban, university- affiliated county teaching hospital. The study population comprised patients seen in the ED during 1994 and 1995 with a discharge diagnosis of DKA or DK and underwent urinalysis within 4 hours of the initial serum electrolyte and ketone determinations. We calculated test sensitivity, along with 95% confidence intervals (CIs). Results: One hundred forty-eight patients with 223 occurrences diagnosed as DKA or DK were seen in the ED during the study period. One hundred fourteen patients with 146 occurrences of DKA or DK met all inclusion criteria; these patients made up the study group. There were 99 cases of DKA and 47 cases of DK. The sensitivity of the UKDT for the detection of ketonemia in all patients with DKA or DK was 97% (95% CI, 94% to 99%) . In the subgroup of patients with DKA, the sensitivity of the UK was 97% (95% CI, 92% to 99%). For patients with DK, the sensitivity of the UK was 98% (95% CI, 89% to 99%). Conclusion: The UKDT is highly sensitive for the presence of serum ketones in patients with DKA and DK. Prospective study is suggested to determine the specificity of the UKDT in this application and to validate its use as a screening tool for the detection of ketonemia in DKA and DK. [Hendey GW, Schwab T, Soliz T: Urine ketone dip test as a screen for ketonemia in diabetic ketoacidosis and ketosis in the emergency department. Ann Emerg Med June 1997; 29:735-738.]     

Screening for ketonemia in patients with diabetes.

STUDY OBJECTIVES: To determine the sensitivity and specificity of the urine ketone dip test as a screening test for ketonemia in hyperglycemic patients and to compare the performance of the urine ketone dip test with the anion gap and serum bicarbonate level. METHODS: This was a prospective study conducted in an urban, university-affiliated public hospital emergency department. Inclusion criteria consisted of (1) patients with known diabetes and hyperglycemia (glucose level>200 mg/dL) and any complaint of illness, or (2) patients with hyperglycemia and symptoms of undiagnosed diabetes mellitus. Urine ketone dip test, serum ketone, and electrolyte levels were determined on all subjects. Sensitivity, specificity, and predictive values along with 95% confidence intervals (CIs) were calculated. RESULTS: The study group comprised 697 patients, including 98 patients with diabetic ketoacidosis (DKA) and 88 with diabetic ketosis (DK). The sensitivity, specificity, positive, and negative predictive values of the urine ketone dip test for the detection of DKA were 99% (95% CI 97% to 100%), 69% (95% CI 66% to 73%), 35% (95% CI 29% to 41%), and 100% (95% CI 99% to 100%), respectively. For DKA and DK, the sensitivity, specificity, positive, and negative predictive values of the urine ketone dip test were 95% (95% CI 90% to 97%), 80% (95% CI 76% to 83%), 63% (95% CI 57% to 69%) and 98% (95% CI 96% to 99%). The anion gap and serum bicarbonate level were less sensitive but more specific than the urine ketone dip test for the detection of DKA and DK. CONCLUSION: The urine ketone dip test has high sensitivity for detecting DKA and a high negative predictive value for excluding DKA in hyperglycemic patients with diabetes with any symptoms of illness. The urine ketone dip test is a better screening test for DKA and DK than the anion gap or serum bicarbonate.     

以酮症起病的成年糖尿病患者自身免疫指标与尿微量白蛋白关系的探讨

目的：研究以酮症起病的成年糖尿病患者自身抗体和免疫球蛋白水平与尿微量白蛋白的关系。方法：回顾性分析42例首诊表现有酮症的成年糖尿患者（K组）和30例新发无酮症倾向的2型糖尿病患者（c组）尿微量白蛋白、谷氨酸脱羧酶抗体（GADAb）、胰岛细胞抗体（ICA）、免疫球蛋白（IgA、IgG、IgM）等指标。以GADAb和／或ICA阳性与否再分为胰岛自身抗体阳性组（A组）和抗体阴性组（B组），对比上述指标。结果：K组尿微量白蛋白阳性率（24h尿微量白蛋白〉30mg为阳性）、GADAb和／或ICA阳性率和IgG水平高于C组；A组尿微量白蛋白阳性率、IgG水平高于B组。结论：以酮症起病的成年糖尿病患者尿微量白蛋白升高与自身免疫异常相关（R=0．621）。     

Unrecognized persistence of beta-hydroxybutyrate in diabetic ketoacidosis.

We quantitated serial serum beta-hydroxybutyrate (beta-OHB) levels using the Ketosite method in 9 children with IDDM who were treated for diabetic ketoacidosis (DKA) and compared them to urinary ketone measurements by dipstick. Persistent elevations of serum beta-OHB were seen in six patients when the urine became clear of ketones; five of these patients had a recurrence of ketonuria. We conclude that many patients recovering from ketoacidosis have continuing elevations of beta-OHB after the urine is free of ketones and this unrecognized abnormality is the likely cause of recurrence of the ketonuria. We recommend that fluid therapy be continued beyond clearance of ketonuria and suggest using the Ketosite method to document restoration of normal serum beta-OHB levels in patients recovering from DKA.     

末梢血β-羟丁酸对糖尿病酮症酸中毒诊断价值的Meta分析

目的 评价末梢血β-羟丁酸在DKA诊断中的价值. 方法 检索Pubmed、ScienceDirect、EMBase、CNKI、维普和万方数据库关于末梢血β-羟丁酸对DKA诊断价值的文献.采用诊断性试验准确性质量评价工具（QUADAS）评价纳入文献质量,并应用Meta-Disc 1.4软件行综合定量评价. 结果 最终纳入文献7篇.末梢血β-羟丁酸在DKA中的诊断价值合并敏感性为0.96（95 ％CI：0.92～0.98）,合并特异性为0.88（95 ％CI：0.86～0.89）,合并诊断优势比为153.01（95％CI：34.70～674.73）,AUCSROC=0.9304（SE=0.0251）,Q指数为0.8658（SE=0.0302）. 结论 末梢血β-羟丁酸诊断DKA的敏感性、特异性均较高,AUCSROC＞0.9,诊断准确性高,适于临床推广应用.     

Evaluation of a bedside blood ketone sensor: the effects of acidosis, hyperglycaemia and acetoacetate on sensor performance.

AIMS: To assess the performance of a handheld bedside ketone sensor in the face of likely metabolic disturbances in diabetic ketoacidosis, namely: pH, glucose and acetoacetate. METHODS: The effects of pH (7.44-6.83), glucose (5-50 mmol/l) and acetoacetate (0-5 mmol/l) were examined in venous blood to investigate the accuracy of betahydroxybutyrate measurement (0-5 mmol/l) by a handheld ketone sensor. Sensor results were compared with a reference method. Linear regression models were fitted to the difference between the methods with the concentration of metabolite as the explanatory factor. RESULTS: Decreasing pH and increasing glucose had no effect on the accuracy of the handheld ketone sensor; the gradients of the fitted lines were -0.14 and -0.003, respectively. The 95% confidence intervals were -0.7-0.4 and -0.01-0.004, respectively (P = 0.59 and 0.4, respectively). In the acetoacetate study, a positive relationship between the sensor and reference method results was found, the gradient was 0.09. The 95% confidence interval was 0.05-0.14 (P < or = 0.001), indicating that high concentrations of acetoacetate interfere with the sensor performance. CONCLUSIONS: Acidosis and hyperglycaemia have minimal effects on the sensor performance. However, high concentrations of acetoacetate result in some overestimation of betahydroxybutyrate. This bedside ketone sensor provides useful data over a broad range of conditions likely to be encountered during moderate to severe diabetic ketoacidosis.     

T2DM酮症患者血清脂联素水平变化及其与血脂的关系

目的探讨2型糖尿病（T2DM）酮症患者血清脂联素（APN）水平的变化，以及其与血脂等因素的相关性。方法选择T2DM酮症患者（酮症组）52例，无酮症患者（非酮症组）58例；另选健康个体54例为正常对照（NC）组。分别测身高、体重、空腹血清APN、血糖、HbA1c、血脂。结果两组患者血清APN水平明显低于NC组（P〈0.01）。酮症组APN水平明显低于非酮症组（P〈0.01）。血清APN水平与HbA1c、TC、TG呈负相关，与HDL-C呈正相关，酮症组患者酮症纠正后APN水平与非酮症患者相比，差异无统计学意义。结论糖尿病酮症期间APN水平明显降低，酮症纠正后恢复。     

尿液HCMV-DNA和血清HCMV-IgM抗体诊断人巨细胞病毒感染的价值

目的提高人巨细胞病毒（HCMV）感染的诊断水平。方法对960例临床疑诊HCMV感染患儿分别应用FQ—PCR、CLIA法检测尿液HCMV—DNA及血清HCMV-IgM抗体水平。结果尿液HCMV-DNA阳性478例,HCMV-IgM抗体阳性206例;二者均阳性191例。478例尿液HCMV—DNA阳性者中,血清IgM抗体阳性HCMV-DNA拷贝数对数均值高于阴性者（P〈0．01）。结论尿液HCMV-DNA定量和血清HCMV-IgM抗体联合检测有助于HCMV感染的诊断。     

糖尿病患者尿液中期因子与糖尿病肾病的关系

目的探讨尿液中期因子（MK）与糖尿病肾病的关系。方法96例糖尿病患者,根据尿白蛋白排泄率分为正常白蛋白尿组（NUAlb组）,微量白蛋白尿组（MUAlb组）,大量白蛋白尿组（CUAlb组）,设对照组（NC组）。用酶联免疫吸附法测定尿液MK水平。结果CUAlb组尿液MK水平高于NC组、NUAlb组及MuAlb组（P〈0．01）,MUAlb组高于NC组及NUAlb组（P〈0．05）,NUAlb组与NC组差异无统计学意义（P〉O．05）。相关分析显示,尿液MK与尿白蛋白排泄率（r=0．40,P〈O．05）及病程（r=0．23,P〈0．05）呈正相关,与内生肌酐清除率（CCr）呈负相关（r=-0．20,P=〈0．05）。结论尿液MK可能参与临床糖尿病肾病的发生。