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目的回顾性分析糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者预后相关因素,以期提高DKA诊治水平及降低病死率。方法收集本院内分泌科2014年1月至2016年12月收治的DKA住院患者临床资料。根据DKA患者是否存活分为存活组和死亡组,并回顾性分析2组患者基本情况、入院时血常规、肝肾功、电解质、C反应蛋白、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation scoreⅡ,APACHEⅡ)等观察指标及预后情况。结果共纳入患者70例,其中男性36例,女性34例,年龄(42.63±15.67)岁。经统计分析结果显示,存活组患者GCS评分[(14.41±1.42)vs(11.36±3.14)]、血磷[(0.96±0.47)mg/L vs(0.68±0.60)mg/L]明显高于死亡组(P<0.05,P<0.01),存活组APACHEⅡ评分[(8.58±4.63)vs(15.73±4.38)]、白细胞总数[(14.82±9.55)×10~9/L vs(22.80±7.67)×10~9/L]、C反应蛋白[(33.67±45.70)mg/L vs(211.39±173.93)mg/L]、肌酐[(87.28±43.89)μmol/L vs(136.47±87.50)μmol/L]、尿素氮[(8.45±5.00)mmol/L vs(14.72±9.23)mmol/L]明显低于死亡组(P<0.05,P<0.01)。DKA患者GCS评分(OR=0.510,P<0.05)越低、APACHEⅡ评分(OR=1.300,P<0.05)及C反应蛋白(OR=1.031,P<0.05)越高,预后则越差。结论 C反应蛋白、GCS评分、APACHEⅡ评分是DKA患者独立的预后因素。
Objective To retrospectively analyze the prognostic factors of patients with diabetic ketoacidosis (DKA) so as to improve the diagnosis and treatment of DKA and reduce the mortality. Methods The clinical data of hospitalized patients with DKA admitted from January 2014 to December 2016 in our hospital were collected. According to the survival of DKA patients were divided into survival group and death group, and retrospectively analyzed the basic situation of two groups of patients, admission blood, liver and kidney function, electrolyte, C-reactive protein, Glasgow coma scale (GCS), acute Physiological and chronic health score Ⅱ (acute physiology and chronic health evaluation score Ⅱ, APACHE Ⅱ) and other indicators and prognosis. Results A total of 70 patients were enrolled, including 36 males and 34 females, with an average age of (42.63 ± 15.67) years. The statistical analysis showed that the GCS score [(14.41 ± 1.42) vs (11.36 ± 3.14) vs P (0.96 ± 0.47) mg / L vs (0.68 ± 0.60) mg / L] (8.58 ± 4.63 vs 15.73 ± 4.38, P <0.05, P <0.01), and the total number of leukocytes [(14.82 ± 9.55) × 10 ~ 9 / L vs (22.80 ± 7.67) × The levels of C-reactive protein ([(33.67 ± 45.70) mg / L vs (211.39 ± 173.93) mg / L] and creatinine (87.28 ± 43.89 μmol / L vs 136.47 ± 87.50 μmol / L, (8.45 ± 5.00) mmol / L vs (14.72 ± 9.23) mmol / L] were significantly lower than those in the death group (P <0.05, P <0.01). The lower the GCS score (OR = 0.510, P <0.05), the higher the APACHEⅡscore (OR = 1.300, P <0.05) and C reactive protein (OR = 1.031, P <0.05). Conclusion C-reactive protein, GCS score and APACHEⅡ score are independent prognostic factors in patients with DKA.