Guerci Bruno, Benichou Muriel, Floriot Michèle, Bohme Philip, Fougnot Sebastien, Franck Patricia, Drouin Pierre
Service de Diabétologie, Maladies Métaboliques & Maladies de la Nutrition, CIC-INSERM, Hôpital Jeanne d'Arc, Nancy, France.
Diabetes Care. 2003 Apr;26(4):1137-41. doi: 10.2337/diacare.26.4.1137.
This study was designed to test the accuracy of capillary ketonemia for diagnosis of ketosis after interruption of insulin infusion.
A total of 18 patients with type 1 diabetes treated by external pump were studied during pump stop for 5 h. Plasma and capillary ketonemia and ketonuria were determined every hour from 7:00 A.M. (time 0 min = T0) to 12:00 P.M. (time 300 min = T300). Plasma beta-hydroxybutyrate (beta-OHB) levels were measured by an enzymatic end point spectrophotometric method, and capillary beta-OHB levels were measured by an electrochemical method (MediSense Optium meter). Ketonuria was measured by a semiquantitative test (Ketodiastix). Positive ketosis was defined by a value of >/=0.5 mmol/l for ketonemia and >/=4 mmol/l (moderate) for ketonuria.
After stopping the pump, concentrations of beta-OHB in both plasma and capillary blood increased significantly at time 60 min (T60) compared with T0 (P < 0.001), reaching maximum levels at T300 (1.30 +/- 0.49 and 1.23 +/- 0.78 mmol/l, respectively). Plasma and capillary beta-OHB values were highly correlated (r = 0.94, P < 0.0001). For diagnosis of ketosis, capillary ketonemia has a higher sensitivity and negative predictive value (80.4 and 82.5%, respectively) than ketonuria (63 and 71.8%, respectively). For plasma glucose levels >/=250 mg/dl, plasma and capillary ketonemia were found to be more frequently positive (85 and 78%, respectively) than ketonuria (59%) (P = 0.017). The time delay to diagnosis of ketosis was significantly higher for ketonuria than for plasma ketonemia (212 +/- 67 vs. 140 +/- 54 min, P = 0.0023), whereas no difference was noted between plasma and capillary ketonemia.
The frequency of screening for ketosis and the efficiency of detection of ketosis definitely may be improved by the use of capillary blood ketone determination in clinical practice.
本研究旨在测试中断胰岛素输注后通过毛细血管血酮血症诊断酮症的准确性。
共对18例使用外置泵治疗的1型糖尿病患者在泵停止工作5小时期间进行研究。从上午7:00（时间0分钟=T0）至中午12:00（时间300分钟=T300）每小时测定血浆和毛细血管血酮血症及尿酮体。血浆β-羟基丁酸（β-OHB）水平采用酶促终点分光光度法测定，毛细血管β-OHB水平采用电化学方法（MediSense Optium血糖仪）测定。尿酮体采用半定量试验（Ketodiastix）测定。酮血症≥0.5 mmol/l且尿酮体≥4 mmol/l（中度）定义为阳性酮症。
停止泵后，与T0相比，血浆和毛细血管血中β-OHB浓度在60分钟（T60）时显著升高（P<0.001），在T300时达到最高水平（分别为1.30±0.49和1.23±0.78 mmol/l）。血浆和毛细血管β-OHB值高度相关（r=0.94，P<0.0001）。对于酮症诊断，毛细血管血酮血症比尿酮体具有更高的敏感性和阴性预测值（分别为80.4%和82.5%）（尿酮体分别为63%和71.8%）。对于血糖水平≥250 mg/dl，血浆和毛细血管血酮血症比尿酮体更频繁呈阳性（分别为85%和78%）（尿酮体为59%）（P=0.017）。尿酮体诊断酮症的延迟时间显著长于血浆酮血症（212±67对140±54分钟，P=0.0023），而血浆和毛细血管血酮血症之间未发现差异。
在临床实践中使用毛细血管血酮测定法肯定可以提高酮症筛查的频率和酮症检测的效率。
Zotero 插件