糖尿病酮症酸中毒期间的氨基酸尿和代谢失调：来自糖尿病肾脏警报（DKA）研究的结果。
Aminoaciduria and metabolic dysregulation during diabetic ketoacidosis: Results from the diabetic kidney alarm (DKA) study.
机构信息
Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
出版信息
J Diabetes Complications. 2022 Jun;36(6):108203. doi: 10.1016/j.jdiacomp.2022.108203. Epub 2022 Apr 28.
OBJECTIVE
We examined changes in the excretion of various amino acids and in glycolysis and ketogenesis-related metabolites, during and after diabetic ketoacidosis (DKA) diagnosis, in youth with known or new onset type 1 diabetes (T1D).
METHODS
Urine samples were collected from 40 youth with DKA (52% boys, mean age 11 ± 4 years, venous pH 7.2 ± 0.1, blood glucose 451 ± 163 mg/dL) at 3 time points: 0-8 h and 12-24 h after starting an insulin infusion, and 3 months after hospital discharge. Mixed-effects models evaluated the changes in amino acids and other metabolites in the urine.
RESULTS
Concentrations of urine histidine, threonine, tryptophan, and leucine per creatinine were highest at 0-8 h (148.8 ± 23.5, 59.5 ± 12.3, 15.4 ± 1.4, and 24.5 ± 2.4% of urine creatinine, respectively), and significantly decreased over 3 months (p = 0.028, p = 0.027, p = 0.019, and p < 0.0001, respectively). Urine histidine, threonine, tryptophan, and leucine per urine creatinine decreased by 10.6 ± 19.2, 0.7 ± 0.9, 1.3 ± 0.9, and 0.5 ± 0.3-fold, respectively, between 0 and 8 h and 3 months.
CONCLUSIONS
In our study, DKA was associated with profound aminoaciduria, suggestive of proximal tubular dysfunction analogous to Fanconi syndrome.
目的
我们研究了在已知或新发 1 型糖尿病（T1D）青少年中，糖尿病酮症酸中毒（DKA）诊断期间和之后，各种氨基酸的排泄以及糖酵解和酮体生成相关代谢物的变化。
方法
我们收集了 40 名 DKA 青少年（52%为男性，平均年龄 11±4 岁，静脉 pH 值 7.2±0.1，血糖 451±163mg/dL）的尿液样本，在开始胰岛素输注后的 0-8 小时和 12-24 小时以及出院后 3 个月这 3 个时间点采集尿液。混合效应模型评估了尿液中氨基酸和其他代谢物的变化。
结果
尿肌酐中组氨酸、苏氨酸、色氨酸和亮氨酸的浓度在 0-8 小时最高（分别为 148.8±23.5、59.5±12.3、15.4±1.4 和 24.5±2.4%），且在 3 个月后显著下降（p=0.028、p=0.027、p=0.019 和 p<0.0001）。尿肌酐中组氨酸、苏氨酸、色氨酸和亮氨酸的浓度在 0-8 小时和 3 个月时分别下降了 10.6±19.2、0.7±0.9、1.3±0.9 和 0.5±0.3 倍。
结论
在我们的研究中，DKA 与明显的氨基酸尿症相关，提示存在类似于 Fanconi 综合征的近端肾小管功能障碍。
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