Di Tommaso M, Aste G, Rocconi F, Guglielmini C, Boari A
Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy.
J Vet Intern Med. 2009 May-Jun;23(3):466-71. doi: 10.1111/j.1939-1676.2009.0302.x.
The diagnosis of canine diabetic ketoacidosis (DKA) usually is based on measurement of urinary acetoacetate (ketonuria). In humans, this test is less sensitive and specific than blood 3-beta-hydroxybutyrate (ketonemia) evaluation.
Ketonemia measurement using a portable meter is more accurate than ketonuria determination with a dipstick to diagnose canine DKA.
Seventy-two client-owned diabetic dogs with ketonemia, ketonuria, or both.
Prospective observational study. Based on blood bicarbonate concentration and anion gap, dogs were divided into 2 groups: patients with DKA (n= 25); patients with diabetic ketosis (n= 47). Sensitivity, specificity, and positive and negative likelihood ratio (LR) at different cut-off points were determined for both ketonemia and ketonuria. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of each diagnostic test to diagnose DKA.
With regard to ketonemia, cut-off values of 2.3 and 4.3 mmol/L revealed 100% sensitivity and 100% specificity, respectively, whereas cut-off values of 2.8 and 3.5 mmol/L showed a -LR of 0.05 and a + LR of 13.16, respectively. With regard to ketonuria, a cut-off value of 1+ revealed 92% sensitivity, 40% specificity, and -LR of 0.20, whereas a cut-off value of 3+ revealed 44% sensitivity, 94% specificity, and +LR of 6.89. The areas under the ROC curves for the ketonemia and ketonuria tests were significantly different (0.97 and 0.81, respectively, P= .003).
Measurement of ketonemia is accurate and more effective than measurement of ketonuria to diagnose canine DKA.
犬糖尿病酮症酸中毒（DKA）的诊断通常基于尿乙酰乙酸（酮尿症）的检测。在人类中，该检测的敏感性和特异性低于血液β-羟基丁酸（酮血症）评估。
使用便携式血糖仪测量酮血症比用试纸条检测酮尿症诊断犬DKA更准确。
72只客户拥有的患有酮血症、酮尿症或两者皆有的糖尿病犬。
前瞻性观察性研究。根据血液碳酸氢盐浓度和阴离子间隙，将犬分为2组：DKA患者（n = 25）；糖尿病酮症患者（n = 47）。确定了酮血症和酮尿症在不同临界点的敏感性、特异性以及阳性和阴性似然比（LR）。采用受试者工作特征（ROC）分析来评估每种诊断检测诊断DKA的准确性。
关于酮血症，2.3 mmol/L和4.3 mmol/L的临界点分别显示出100%的敏感性和100%的特异性，而2.8 mmol/L和3.5 mmol/L的临界点分别显示出阴性似然比为0.05和阳性似然比为13.16。关于酮尿症，1+的临界点显示出92%的敏感性、40%的特异性和阴性似然比为0.20，而3+的临界点显示出44%的敏感性、94%的特异性和阳性似然比为6.89。酮血症和酮尿症检测的ROC曲线下面积显著不同（分别为0.97和0.81，P = .003）。
测量酮血症诊断犬DKA比测量酮尿症更准确、更有效。
