糖尿病高血糖危象患者血清降钙素原的变化

Changes of serum procalcitonin level in patients with diabetic hyperglycemic crisis

摘要:

目的  评价糖尿病高血糖危象（HC）患者血清降钙素原（PCT）水平的变化及其影响因素。方法  将HC患者分为HC感染组、HC非感染组，另设糖尿病非HC组。分别测定3组患者入院时的PCT、血乳酸、血白细胞计数（WBC）、中性粒细胞率、血尿淀粉酶等临床指标。比较各组PCT水平的变化。将HC非感染组分为高血糖高渗综合征（HHS）亚组和酮症酸中毒（DKA）亚组，比较两组PCT水平的变化，分析PCT与各临床指标之间的关系。结果  HC感染组PCT值明显高于两组无感染的糖尿病患者，但在无感染的情况下，糖尿病并HC组PCT水平仍然明显高于糖尿病无HC组。对两组HC患者进行受试者工作特征曲线（ROC）分析，PCT值ROC曲线下面积仅0.685，甚至小于外周血WBC和中性粒细胞率的ROC曲线下面积。非感染DKA亚组与非感染HHS亚组PCT水平比较差异无统计学意义，分别对两组进行以PCT为因变量、各临床指标为自变量的多元逐步回归分析，两个回归方程都纳入血乳酸这一指标。结论  糖尿病并HC时，即使在无感染的情况下，血PCT值也常明显升高。不管是HHS还是DKA，PCT的升高与血乳酸水平的升高密切相关。在HC发生时PCT对感染的诊断价值有限。

Abstract:

Objective To explore the changes of serum procalcitonin (PCT) in patients with diabetic hyperglycemic crisis (HC). Methods The serum PCT, lactic acid, white blood cell (WBC), neutrophil rate, blood amylase, urinary amylase and the other clinical parameters were determined in 160 patients with HC and 50 diabetic patients without HC. The 160 HC patients were divided into 2 groups: HC with infection and HC without infection. The PCT level was compared between the three groups. The HC patients without infection were divided into hyperosmolar hyperglycemic syndrome (HHS) subgroup and diabetic ketoacidosis (DKA) subgroup. The PCT level was compared between the two subgroups, the relationships of PCT with other clinical parameters were analyzed. Results The serum PCT levels in the HC patients with infection were remarkedly higher than those in the HC patients without infection and the diabetic patients without HC. But when there was no infection, serum PCT level in the HC patients was still higher than that in the diabetic patients without HC. Receiver operating characteristic (ROC) curve presented that the area under curve (AUC) of PCT (0.685) was smaller than that of white blood cell (0.706) and neutrophil rate (0.702). In the HHS and DKA subgroups without infection, the serum PCT was positively correlated with serum lactic acid (r = 0.411 and 0.514). Serum lactic acid entered respectively the multiple regression equations of PCT as a dependent variable. Conclusions Even if there is no infection, serum PCT is higher in HC patients than in diabetic patients without HC. Serum lactic acid is the independent contributing factor for PCT. The diagnostic value of PCT for infection is limited in diabetic patients with HC.