高血糖患者尿酮体（乙酰乙酸）与毛细血管血酮体（3-β-羟基丁酸）之间的相关性

Correlation between urine ketones (acetoacetate) and capillary blood ketones (3-beta-hydroxybutyrate) in hyperglycaemic patients.

作者信息

Taboulet P, Deconinck N, Thurel A, Haas L, Manamani J, Porcher R, Schmit C, Fontaine J-P, Gautier J-F

机构信息

Emergency department, hôpital Saint-Louis (APHP), université Paris-VII, 1 avenue Claude-Vellefaux, 75475 Paris cedex 10, France.

出版信息

Diabetes Metab. 2007 Apr;33(2):135-9. doi: 10.1016/j.diabet.2006.11.006. Epub 2007 Feb 21.

DOI:10.1016/j.diabet.2006.11.006

PMID:17320448

Abstract

AIMS

To facilitate the transition from urine ketones (acetoacetate) to capillary blood ketones (3-beta-hydroxybutyrate), we studied the correlation between these two tests.

METHODS

Retrospective study of all patients with blood glucose greater than or equal to 2.5 g/l on arrival in the Emergency Department. We studied the correlation between urine ketones (Clinitek 50, Bayer) and capillary blood ketones (Optium, Abbott). We then compared the relative risks (RR) of ketoacidosis and hospitalization associated with each of these tests.

RESULTS

In 33 months, 529 adult patients with both urine and blood testing for ketones were enrolled (ketoacidosis 8%, admission rate 49%). Urine ketones scored as +, ++ and +++ corresponded to median capillary blood ketone levels of 0.5 mmol/l (IQR: 0.1-0.9), 0.7 mmol/l (IQR: 0.2-1.8) and 3 mmol/l (IQR: 1.4-5.2), respectively. RRs of ketoacidosis or hospitalization associated with blood ketones greater than or equal to 3 mmol/l were higher than those associated with +++ urine ketones: 74 (95% confidence interval [CI]: 48-88) and 2.9 (95% CI: 2.5-3) versus 31 (95% CI: 18-45) and 2 (95% CI: 1.7-2.1), respectively.

CONCLUSIONS

In hyperglycaemic patients in the Emergency Department, a good correlation was observed between urine ketones and capillary blood ketones for low values, but a poor correlation was observed for high values. Either test can therefore be used to exclude ketosis, but the capillary blood ketones test is more accurate to confirm ketoacidosis.

摘要

目的

为促进从尿酮体（乙酰乙酸）检测向毛细血管血酮体（3-β-羟基丁酸）检测的转变，我们研究了这两种检测方法之间的相关性。

方法

对所有急诊时血糖大于或等于2.5 g/l的患者进行回顾性研究。我们研究了尿酮体（拜耳Clinitek 50）与毛细血管血酮体（雅培Optium）之间的相关性。然后比较了与每种检测方法相关的酮症酸中毒和住院的相对风险（RR）。

结果

在33个月内，共纳入了529例同时进行尿酮体和血酮体检测的成年患者（酮症酸中毒发生率8%，住院率49%）。尿酮体评分为+、++和+++时，对应的毛细血管血酮体中位数水平分别为0.5 mmol/l（四分位间距：0.1 - 0.9）、0.7 mmol/l（四分位间距：0.2 - 1.8）和3 mmol/l（四分位间距：1.4 - 5.2）。血酮体大于或等于3 mmol/l时，与酮症酸中毒或住院相关的RR高于尿酮体为+++时的RR：分别为74（95%置信区间[CI]：48 - 88）和2.9（95% CI：2.5 - 3），而尿酮体为+++时分别为31（95% CI：18 - 45）和2（95% CI：1.7 - 2.1）。