定量毛细血管β-羟丁酸检测在糖尿病酮症酸中毒诊断中的效能：与硝普钠反应法定量血清酮检测的比较

Lertwattanarak Raweewan, Plainkum Parit

J Med Assoc Thai. 2014 Mar;97 Suppl 3:S78-85.

OBJECTIVE

To examine the efficacy of using capillary beta-hydroxy butyrate (beta-OHB) levels in comparison with serum ketone levels in distinguishing diabetic ketoacidosis (DKA) from non-DKA states in patients who had severe hyperglycemia and to determine a cut-off level of capillary beta-OHB that is best for the diagnosis of DKA.

MATERIAL AND METHOD

Diabetic patients who presented with capillary blood glucose of > or = 400 mg/dL were studied. Capillary beta-OHB levels were measured by using a ketometer (OptiumXceed) at the same time as blood sample collection for biochemical tests and serum ketone measurement using nitroprusside reaction. The American Diabetes Association (ADA) criteria 2012 were used as the gold standard in the diagnosed of DKA.

RESULTS

There were 13 cases (34.2%) with DKA (DKA group) and 25 cases (65.8%) without DKA (non-DKA group). There was no difference in plasma glucose levels between both groups. (DKA group = 714.2 +/- 367.6 mg/dl vs. non-DKA group = 589.4 +/- 220.2 mg/dl). The DKA group had significantly higher serum ketone (7.2 +/- 3.6 vs. 0.28 +/- 0.05 mmol/L, p < 0.001) and capillary beta-OHB levels (4.3 +/- 0.7 vs. 1.0 +/- 1.1 mmol/L, p < 0.001) than did the non-DKA group. Capillary beta-OHB levels significantly correlated to serum anion gap values (r = 0.828, p < 0.001), serum bicarbonate (r = 0.715, p < 0.001), and ketone (r = 0.72, p < 0.001) levels. ROC analyses showed that a capillary beta-OHB level of > 3.1 mmol/L was the best cut-off level for the diagnosis of DKA, and yielded a sensitivity of 100% (95% CI = 75.1-100) with a specificity of 96% (95% CI = 79.6-99.3).

CONCLUSION

Using a cut-off capillary beta-OHB level of > 3.1 mmol/L is highly effective in the diagnosis of DKA in patients who presented with hyperglycemia. Quantitative measurement of capillary beta-OHB levels using a ketometer offers an immediate result that is useful for a reliable triage of screening for DKA in patients presented with severe hyperglycemia.

目的

研究在严重高血糖患者中，使用毛细血管β-羟基丁酸（β-OHB）水平与血清酮水平相比，用于区分糖尿病酮症酸中毒（DKA）和非DKA状态的疗效，并确定最适合诊断DKA的毛细血管β-OHB临界值。

材料与方法

对毛细血管血糖≥400mg/dL的糖尿病患者进行研究。在采集血样进行生化检测和使用硝普钠反应测定血清酮的同时，使用酮体仪（OptiumXceed）测量毛细血管β-OHB水平。采用2012年美国糖尿病协会（ADA）标准作为诊断DKA的金标准。

结果

有DKA的患者13例（34.2%）（DKA组），无DKA的患者25例（65.8%）（非DKA组）。两组间血浆葡萄糖水平无差异。（DKA组=714.2±367.6mg/dl，非DKA组=589.4±220.2mg/dl）。DKA组的血清酮（7.2±3.6 vs. 0.28±0.05mmol/L，p<0.001）和毛细血管β-OHB水平（4.3±0.7 vs. 1.0±1.1mmol/L，p<0.001）显著高于非DKA组。毛细血管β-OHB水平与血清阴离子间隙值（r=0.828，p<0.001）、血清碳酸氢盐（r=0.715，p<0.001）和酮（r=0.72，p<0.001）水平显著相关。ROC分析显示，毛细血管β-OHB水平>3.1mmol/L是诊断DKA的最佳临界值；敏感性为100%（95%CI=75.1-100），特异性为96%（95%CI=79.6-99.3）。