Schwab T M, Hendey G W, Soliz T C
Division of Emergency Medicine, University Medical Center, University of California, San Francisco, USA.
Ann Emerg Med. 1999 Sep;34(3):342-6. doi: 10.1016/s0196-0644(99)70128-9.
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.
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.
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.
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.
确定尿酮试纸检测法作为高血糖患者酮血症筛查试验的敏感性和特异性，并比较尿酮试纸检测法与阴离子间隙和血清碳酸氢盐水平的性能。
这是一项在城市中一家大学附属医院急诊科进行的前瞻性研究。纳入标准包括：（1）已知患有糖尿病且血糖升高（血糖水平>200mg/dL）并伴有任何疾病主诉的患者，或（2）血糖升高且有未确诊糖尿病症状的患者。对所有受试者进行尿酮试纸检测、血清酮检测和电解质水平测定。计算敏感性、特异性、预测值以及95%置信区间（CI）。
研究组包括697例患者，其中98例患有糖尿病酮症酸中毒（DKA），88例患有糖尿病酮症（DK）。尿酮试纸检测法检测DKA的敏感性、特异性、阳性预测值和阴性预测值分别为99%（95%CI 97%至100%）、69%（95%CI 66%至73%）、35%（95%CI 29%至41%）和100%（95%CI 99%至100%）。对于DKA和DK，尿酮试纸检测法的敏感性、特异性、阳性预测值和阴性预测值分别为95%（95%CI 90%至97%）、80%（95%CI 76%至83%）、63%（95%CI 57%至69%）和98%（95%CI 96%至99%）。在检测DKA和DK方面，阴离子间隙和血清碳酸氢盐水平的敏感性低于尿酮试纸检测法，但特异性更高。
尿酮试纸检测法对检测DKA具有高敏感性，对排除有任何疾病症状的糖尿病高血糖患者的DKA具有高阴性预测值。尿酮试纸检测法在筛查DKA和DK方面比阴离子间隙或血清碳酸氢盐检测更好。
