血清β-羟丁酸在糖尿病酮症/酮症酸中毒中的诊断价值

目的 探讨血清β-羟丁酸在糖尿病酮症/酮症酸中毒(DK/DKA)中的意义和诊断价值。方法 回顾2011年5月至2013年5月四川大学华西医院内分泌科1 209例糖尿病无酮症患者（DM组）,262例患者（DK/DKA组）和480例同时期行体检的健康对照者（正常对照组）的临床资料，采用logistic回归及ROC曲线判断β-羟丁酸的诊断价值。结果 DK/DKA组患者血清β-羟丁酸水平高于DM组和正常对照组（P <0.01），DK/DKA组血清β-羟丁酸较尿酮体更早转阴（P <0.01）。Logistic回归分析发现血清β羟丁酸为DK/DKA的独立危险因素。β-羟丁酸诊断DK/DKA时的ROC曲线下面积为0.975，取诊断临界值为1 mmol/L作为诊断切点，敏感度85.1％，特异度95.3％，阳性预测值80.36%，阴性预测值96.89%；以血清β羟丁酸0.66 mmol/L作为筛选切点，敏感度95%，特异性89.2%，阳性预测值66.41%，阴性预测值99.9%。结论 以血清β羟丁酸≥1 mmol/L诊断DK/DKA有较高诊断准确性，血清β羟丁酸≤0.66 mmol/L时可认为糖尿病患者未合并DK/DKA。

The Diagnostic Value of Serum Beta-hydroxybutyrate in Diabetic Ketosis or Diabetic Ketoacidosis

【Abstract】 Objective To determine the diagnostic value of serum beta-hydroxybutyrate (βOHB) in diabetic ketosis or diabetic ketoacidosis. Methods We conducted a retrospective review of clinical data, in West China Hospital from May 2011 to May 2013, of 1 209 patients with non-ketosis diabetics (DM group), 262 patients with diabetic ketosis or diabetic ketoacidosis (DK/DKA group), and 480 healthy people undergoing routine medical examinations (normal control group). Logistic regression analyses and ROC curves were performed in determining the diagnostic value of βOHB for DK/DKA. Results The level of serum βOHB was much higher in the DK/DKA patients than that of the participants in the DM group and normal control group (P<0.01). The serum βOHB turned negative earlier than urine ketone (P<0.01) in the DK/DKA patients. The logistic regression analysis indicated that βOHB was one of the independent risk factors for DK/DKA. The βOHB had an area under of 0.975 in ROC curve, with 1 mmol/L 〔sensitivity (Sen.) 85.1%, specificity (Spe.) 95.3%, positive predictive value (PV+) 80.36%, negative predictive value (PV-) 96.89%〕 as a diagnostic point for DK/DKA and 0.66 mmol/L (Sen. 95%, Spe.89.2%, PV+ 66.41%, PV- 99.9%) as a screening point. Conclusion Diabetic patients with a level or higher than 1 mmol/L serum βOHB can accurately predict DK/DKA. Patients with a level or lower than 0.66 mmol/L serum βOHB are unlikely to have DK/DKA.