Wen Song, Xu Dongxiang, Yuan Yue, Xu Zhimin, Li Yanyan, Gong Min, Yuan Xinlu, Zhou Ligang
Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People's Republic of China.
Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, 201399, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Nov 1;17:4115-4133. doi: 10.2147/DMSO.S487398. eCollection 2024.
Serum tumor markers have been discovered to be elevated in individuals with diabetes mellitus (DM); however, their significance in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemia (HHS) is unknown. We evaluated these indicators in the patients with DKA and HHS.
We retrospectively collected the laboratory data of 565 diabetic patients from Shanghai Pudong Hospital between Jan, 2019 and May, 2023, including 300 patients with type 2 diabetes mellitus (T2DM), 206 with DKA, and 59 with HHS. Serum tumor biomarkers and further clinical laboratory tests were compared among the three groups. Patients with conspicuous tumor evidence were excluded from the study.
We found significantly higher levels of carbohydrate antigen 199 (CA199) in DKA (p<0.01), carcinoembryonic antigen (CEA), complex prostate specific antigen (CPSA) (p<0.01), prostate specific antigen (PSA) (p<0.05) in HHS, as well as the plasma lipid profile, iron, and electrolytes, in addition to decreased thyroid function, hepatic and renal function, and cardiac function (p<0.05). A Spearman correlational study revealed that osmolar levels were significantly positively correlated with myoglobin (MYO) and cardiac troponin I (cTNI), whereas serum iron concentration (r=0.520) was positively correlated with CEA levels in HHS. pH was negatively correlated with CA199 (r=-0.195), while HbA1c (r=0.22), globin (r=0.341), and total cholesterol (TC) (r=0.191) were positively correlated with elevated CA199 levels. Moreover, the multilinear regression investigation identified osmolarity as a significant determinant for CEA, as well as other parameters, and all proved to be proper predictors for CEA in HHS via ROC curve establishment.
Elevated CA199 levels in DKA were associated with acidosis, whereas HHS with elevated CEA levels may be related to iron homeostasis and could be predicted via the osmolar degree and other predictors.
血清肿瘤标志物已被发现在糖尿病（DM）患者中升高；然而，它们在糖尿病酮症酸中毒（DKA）和高渗高血糖状态（HHS）中的意义尚不清楚。我们评估了DKA和HHS患者的这些指标。
我们回顾性收集了2019年1月至2023年5月期间上海浦东医院565例糖尿病患者的实验室数据，包括300例2型糖尿病（T2DM）患者、206例DKA患者和59例HHS患者。比较了三组患者的血清肿瘤生物标志物及进一步的临床实验室检查结果。有明显肿瘤证据的患者被排除在研究之外。
我们发现DKA患者的糖类抗原199（CA199）水平显著升高（p<0.01），HHS患者的癌胚抗原（CEA）、复合前列腺特异性抗原（CPSA）（p<0.01）、前列腺特异性抗原（PSA）（p<0.05）水平升高，同时血浆脂质谱、铁和电解质水平也有变化，此外甲状腺功能、肝肾功能和心功能下降（p<0.05）。一项Spearman相关性研究显示，渗透压水平与肌红蛋白（MYO）和心肌肌钙蛋白I（cTNI）显著正相关，而血清铁浓度（r=0.520）与HHS患者的CEA水平正相关。pH与CA199呈负相关（r=-0.195），而糖化血红蛋白（HbA1c）（r=0.22）、球蛋白（r=0.341）和总胆固醇（TC）（r=0.191）与升高的CA199水平呈正相关。此外，多线性回归研究确定渗透压是CEA以及其他参数的重要决定因素，并且通过建立ROC曲线证明所有这些在HHS中都是CEA的合适预测指标。
DKA中CA199水平升高与酸中毒有关，而CEA水平升高的HHS可能与铁稳态有关，并且可以通过渗透压程度和其他预测指标进行预测。
