Bektas Firat, Eray Oktay, Sari Ramazan, Akbas Halide
Department of Emergency Medicine, School of Medicine, University of Akdeniz, Antalya, Turkey.
Endocr Res. 2004 Aug;30(3):395-402. doi: 10.1081/erc-200035231.
The aim of our study was to determine the utility of point-of-care blood ketone testing in diabetic patients presenting to the emergency department. In this prospective, observational clinical study, patients with known or newly diagnosed diabetes mellitus presenting to our tertiary care university emergency department with any nontrauma related medical complaint and a high fingerstick glucose (> or =200 mg/dL) were eligible for inclusion. Capillary blood beta-hydroxybutyrate (beta-HBA), venous blood beta-HBA level, venous blood glucose level, arterial blood gas analysis, and urine ketone dipstickstick were measured in each patient as primary outcome measures. Of the 479 diabetic patients presenting during the study period, a total of 139 diabetic patients with high capillary blood glucose level (> or =200 mg/dL) and a positive capillary blood beta-HBA (> or =0.1 mmol/L) were included in the study. Hyperketonemia (> or =0.42 mmol/L) was found in 48 of these patients by Sigma Diagnostics reference testing (diabetic ketosis in 35%). The calculated blood pH was less than 7.3 in 18 of these 48 patients (ketoacidosis in 31%). Capillary and venous blood beta-hydroxybutyrate levels were not statistically different from each other (P = 0.824). There was a positive correlation between capillary and venous blood beta-HBA levels (r = 0.488, P < 0.001). The sensitivity and specificity of urine ketone dipstick testing and capillary blood ketone testing in determining diabetic ketoacidosis were 66% and 78%, and 72% and 82%; and in determining hyperketonemia (both in diabetic ketosis and diabetic ketoacidosis) were 82% and 54%, and 91% and 56%, respectively. A rapid, bedside capillary blood ketone test for beta-HBA can accurately measure blood concentrations of beta-HBA in diabetic patients in an emergency department setting. This device can be used as a reliable diagnostic test to detect emergency metabolic problems in diabetic patients, such as diabetic ketosis or ketoacidosis.
我们研究的目的是确定即时检测血酮在急诊科糖尿病患者中的应用价值。在这项前瞻性观察性临床研究中，已知或新诊断为糖尿病的患者因任何非创伤性相关医疗主诉且指尖血糖较高（≥200mg/dL）前来我们的三级医疗大学急诊科就诊，符合纳入标准。每位患者均测量毛细血管血β-羟基丁酸（β-HBA）、静脉血β-HBA水平、静脉血糖水平、动脉血气分析以及尿酮试纸检测结果作为主要观察指标。在研究期间前来就诊的479例糖尿病患者中，共有139例毛细血管血糖水平较高（≥200mg/dL）且毛细血管血β-HBA阳性（≥0.1mmol/L）的糖尿病患者被纳入研究。通过西格玛诊断参考检测，这些患者中有48例存在高酮血症（≥0.42mmol/L）（35%为糖尿病酮症）。在这48例患者中，有18例计算得出的血pH值小于7.3（31%为酮症酸中毒）。毛细血管血和静脉血β-羟基丁酸水平在统计学上无差异（P = 0.824）。毛细血管血和静脉血β-HBA水平之间存在正相关（r = 0.488，P < 0.001）。尿酮试纸检测和毛细血管血酮检测在诊断糖尿病酮症酸中毒时的敏感性和特异性分别为66%和78%，以及72%和82%；在诊断高酮血症（包括糖尿病酮症和糖尿病酮症酸中毒）时分别为82%和54%，以及91%和56%。用于检测β-HBA的快速床旁毛细血管血酮检测能够在急诊科环境中准确测量糖尿病患者血液中的β-HBA浓度。该设备可作为一种可靠的诊断检测方法，用于检测糖尿病患者的紧急代谢问题，如糖尿病酮症或酮症酸中毒。
