糖尿病病人血D-3-羟丁酸与尿酮体关系的研究

目的 探讨糖尿病时血D-3-羟丁酸与尿酮体定性测定的关系。方法 观察我院住院治疗的糖尿病无酮症患者42例，糖尿病酮症酸中毒患者19例以及健康体检者60例的血D-3-羟丁酸、尿酮体的变化；11例糖尿病酮症酸中毒患者治疗前及治疗后D-3-羟丁酸、尿酮体的变化。结果 糖尿病无酮症组D-3-羟丁酸阳性率与酮体阳性率有显著差异，糖尿病无酮症组与糖尿病酮症酸中毒组D-3-羟丁酸水平有很显著差异；糖尿病酮症酸中毒组在治疗前D-3-羟丁酸水平明显升高，而尿酮体的升高幅度低于D-3-羟丁酸，治疗后D-3-羟丁酸水平开始直线下降，而尿酮体却在明显升高后降低。结论 D-3-羟丁酸是糖尿病的重要监测指标，可对糖尿病酮症酸中毒提供早期诊断，可避免治疗过程中单纯测定尿酮体给人造成的误导，可对治疗效果提供准确判断。

A study on the levels of d - 3 - hydroxybutyrate and ketone in diabetes patients

Objective To investigate the association between the level of D-3-hydroxybutyrate and the detection of ketone in diabetes patients.Methods Ninety patients of insulin-dependent diabetes mellitus(IDDM) with ketoacidosis,42 patients of IDDM without ketoacidosis,and 60 healthy subjects were studied.The level of serum d-3-hydroxybutyrate was determined by kinetic enzymatic method and urine ketone was detected by using the Bayer Clinitek 500 analyzer.Results The positive rate of d-3-hydroxybutyrate was higher than that of qualitative ketone test in IDDM patients without ketoacidosis.The level of serum D-3-hydroxybutyrate was higher in patients with ketoacidosis than that in patients without ketoacidosis.D-3-hydroxybutyrate enhanced significantly before treatment in patients with ketoacidosis,the extent of the increase of urine ketone was less than D-3-hydroxybutyrate.D-3-hydroxybutyrate level decreased to normal after treatment.But urine ketone decreased after sharply increase.Conclusion D-3-hydroxybutyrate is an important index for the monitoring of IDDM.It may avoid misleading of only surveying urine ketone during treatment and may help the early diagnosis of diabetes associated ketoacidosis and precise judgment of the effect of treatment.