血清尿酸与儿童初发1型糖尿病酮症酸中毒相关性研究

doi:10.12372/jcp.2023.22e1769

摘要/Abstract

摘要：

目的探讨血清尿酸（SUA）与儿童初发1型糖尿病（T1DM）合并酮症酸中毒（DKA）发生的相关性。方法回顾性分析2015年3月—2022年6月收治的T1DM患儿的临床资料，比较DKA组与非DKA组患儿的临床特点，分析SUA水平与初发T1DM发生DKA的相关性。结果纳入358例T1DM患儿，男190例、女168例，中位年龄5.8（3.0~8.9）岁。DKA组186例（52.0%），非DKA组172例；轻度DKA组57例、中度64例、重度65例。共49例高尿酸血症患儿，DKA组43例（23.1%）。DKA组入院时血糖、血清尿酸、入院时合并感染比例高于非DKA组，C肽、肾小球滤过率低于非DKA组，差异均有统计学意义（均P<0.05）。绘制ROC曲线，发现SUA协助诊断初发T1DM合并DKA发生的曲线下面积为0.94（95%CI：0.91~0.97），以SUA≥294.2μmol/L为截断值，诊断初发T1DM合并DKA发生的灵敏度和特异度分别为92.5%和89.0%。Spearman秩相关分析显示，SUA与初发T1DM患儿的pH值和HCO^-₃值呈显著负相关（P<0.01）。非DKA组及不同程度DKA组间SUA水平差异有统计学意义（P<0.01）。两两比较发现，轻度、中度、重度DKA组SUA水平高于非DKA组，差异均有统计学意义（P<0.05）。结论 SUA水平测定对协助评估初发T1DM是否合并DKA发生有一定临床意义，有利于病情评估，可在基层医院开展。

关键词: 糖尿病酮症酸中毒, 1型糖尿病, 血清尿酸, 儿童

Abstract:

Objective To explore the correlation between serum uric acid (SUA) and diabetic ketoacidosis (DKA) of children in initially diagnosed type 1 diabetes (T1DM). Methods The clinical data of children with T1DM admitted from March 2015 to June 2022 were retrospectively analyzed. The clinical characteristics of children between DKA group and non-DKA group were compared, and the correlation between SUA level and the occurrence of DKA in children with initially diagnosed T1DM was analyzed. Results A total of 358 children with T1DM (190 boys and 168 girls) were included, and the median age was 5.8 (3.0-8.9) years. There were 186 children (52.0%) in the DKA group and 172 in the non-DKA group. There were 57 children in the mild DKA group, 64 in the moderate DKA group and 65 in the severe DKA group. A total of 49 children with HUA were diagnosed, including 43 (23.1%) in the DKA group. The blood glucose, SUA level and the proportion of co-infection on admission in the DKA group were higher than those in the non-DKA group, and the C-peptide and glomerular filtration rate in the DKA group were lower than those in the non-DKA group, and the differences were statistically significant (all P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the ROC curve of SUA predicting the DKA occurrence in children with initially diagnosed T1DM was 0.94 (95%CI: 0.91-0.97). When SUA≥294.2 μmol/L, the sensitivity and specificity predicting the DKA occurrence were 92.5% and 89.0%, respectively. Spearman rank correlation analysis showed that the SUA level was negatively correlated with the valueslevels of pH and HCO^-₃ in children with initially diagnosed T1DM (P<0.01). There were statistically significant differences in SUA levels between non-DKA group and DKA groups with different degrees (P<0.01). Pairwise comparison showed that SUA levels in mild, moderate and severe DKA groups were higher than those in non-DKA group, with statistical significance (P<0.05). Conclusions The determination of SUA level has certain clinical significance in assisting the assessment of whether the initial T1DM is combined with DKA, which is conducive to the disease assessment and can be carried out in grass-roots hospitals.

Key words: diabetes ketoacidosis, type 1 diabetes, serum uric acid, child

刘芳, 曹冰燕, 王诗琦, 陈琼, 卫海燕. 血清尿酸与儿童初发1型糖尿病酮症酸中毒相关性研究[J]. 临床儿科杂志, 2023, 41(6): 424-429.

LIU Fang, CAO Bingyan, WANG Shiqi, CHEN Qiong, WEI Haiyan. Correlation analyses between serum uric acid and diabetic ketoacidosis in children with initially diagnosed type 1 diabetes[J]. Journal of Clinical Pediatrics, 2023, 41(6): 424-429.

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项目	DKA组(n=186)	非DKA组(n=172)	统计量	P
年龄[M(P₂₅~P₇₅)]/岁	5.6(2.9~8.8)	6.1(3.2~9.1)	Z=0.43	0.683
男性[n(%)]	95(51.1)	95(55.2)	χ²=0.62	0.459
出生体重(x±s)/kg	3.4±1.0	3.3±0.5	t=0.69	0.499
出生情况[n(%)]			χ²=4.77	0.092
早产	5(2.7)	12(7.0)
足月产	181(97.3)	159(92.4)
过期产	0(0)	1(0.6)
入院时合并感染[n(%)]	67(36.8)	44(25.6)	χ²=4.55	0.039
青春期[n(%)]	16(8.6)	24(14.0)	χ²=2.58	0.131
入院血糖[M(P₂₅~P₇₅)]/mmol·L^-1	24.6(19.1~31.7)	20.3(14.2~26.8)	Z=4.50	<0.001
HbA1c(x±s)/%	11.6±2.1	11.7±2.4	t=0.15	0.883
C肽[M(P₂₅~P₇₅)]/ng·mL^-1	0.3(1.8~0.4)	0.4(0.2~0.6)	Z=3.92	<0.001
Ins[M(P₂₅~P₇₅)]/IU·mL^-1	1.7(0.8~5.0)	179(0.8~4.7)	Z=0.28	0.788
BUN[M(P₂₅~P₇₅)]/mmol·L^-1	4.2(3.3~5.2)	5.1(3.9~6.3)	Z=4.10	0.709
SCr[M(P₂₅~P₇₅)]/μmol·L^-1	42.9(37.4~49.0)	37.0(29.0~44.8)	Z=5.40	0.112
SUA[M(P₂₅~P₇₅))]/μmol·L^-1	373.8(330.8~426.8)	153.3(105.3~216.9)	Z=14.30	<0.001
GFR[M(P₂₅~P₇₅)]/mL·min^-1·1.73m^-2	97.5(81.5~111.9)	112.2(87.2~158.5)	Z=4.94	<0.001