Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine, Wenzhou Medical College, Wenzhou, China.
Clin Chim Acta. 2011 Jan 30;412(3-4):286-91. doi: 10.1016/j.cca.2010.10.020. Epub 2010 Oct 29.
A high anion gap in diabetic ketoacidosis (DKA) suggests that some unmeasured anions must contribute to the generation of the anion gap. We investigated the contribution of D-lactate to the anion gap in DKA.
Diabetic patients with and without DKA and high anion gap were recruited. Plasma D-lactate was quantified by HPLC. Plasma methylglyoxal was assayed by liquid chromatography-tandem mass spectrometry.
The plasma fasting glucose, β-hydroxybutyrate, and blood HbA1c levels were highly elevated in DKA. Plasma anion gap was significantly increased in DKA (20.59±6.37) compared to either the diabetic (7.50±1.88) or the control group (6.53±1.75) (p<0.001, respectively). Moreover, plasma D-lactate levels were markedly increased in DKA (3.82±2.50 mmol/l) compared to the diabetic (0.47±0.55 mmol/l) or the control group (0.25±0.35 mmol/l) (p<0.001, respectively). Regression analysis demonstrated that D-lactate was associated with acidosis and anion gap (r=0.686, p<0.001).
Plasma D-lactate levels are highly elevated and associated with metabolic acidosis and the high anion gap in DKA. Laboratory monitoring of d-lactate will provide valuable information for assessment of patients with DKA.
糖尿病酮症酸中毒（DKA）患者阴离子间隙升高提示一定有未测阴离子参与产生阴离子间隙。本研究旨在探讨 D-乳酸在 DKA 患者阴离子间隙升高中的作用。
招募伴有或不伴有高阴离子间隙的 DKA 患者。采用高效液相色谱法检测血浆 D-乳酸浓度，液相色谱-串联质谱法检测血浆甲基乙二醛浓度。
DKA 患者空腹血糖、β-羟丁酸和血 HbA1c 水平显著升高。与糖尿病组（7.50±1.88）或对照组（6.53±1.75）相比，DKA 患者的阴离子间隙显著增加（20.59±6.37，p<0.001）。此外，与糖尿病组（0.47±0.55 mmol/l）或对照组（0.25±0.35 mmol/l）相比，DKA 患者的血浆 D-乳酸水平明显升高（3.82±2.50 mmol/l，p<0.001）。回归分析显示，D-乳酸与酸中毒和阴离子间隙相关（r=0.686，p<0.001）。
DKA 患者的血浆 D-乳酸水平显著升高，并与代谢性酸中毒和高阴离子间隙相关。D-乳酸的实验室监测将为 DKA 患者的评估提供有价值的信息。
