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目的:对糖尿病酸中毒合并感染患者血清中降钙素原(PCT)和乳酸水平检测的意义及价值进行探讨。方法:搜集2014-02-2016-08于我院急诊内科住院的所有糖尿病酸中毒合并感染的患者60例作为感染组,选取同期糖尿病酸中毒但未合并感染的患者60例作为非感染性对照。检测患者血清中的PCT和乳酸水平,以及酮体、肝肾功能(ALT和AST、Scr和BUN)、血常规[白细胞计数(WBC)、中性粒细胞百分比]。结果:感染组WBC、中性粒细胞百分比、酮体、AST、BUN水平显著高于对照组(P<0.05),感染组患者血清PCT和乳酸水平均显著高于对照组(P<0.05)。血清PCT和乳酸水平的升高是糖尿病酸中毒合并感染最强的风险预测因素,其OR值分别为3.114和2.072(P<0.05)。血清PCT单独对糖尿病酸中毒合并感染诊断的曲线下面积(AUC)为0.875(P=0.001)高于乳酸的AUC为0.759(P=0.003),但是其诊断的敏感性(83.8%)却高于PCT(73.3%),而PCT的特异性(86.7%)却要高于乳酸的诊断特异性(71.7%),PCT与乳酸联合诊断的AUC(0.881,P<0.001)要高于单独指标的诊断,而且其敏感性(88.6%)和特异性(89.4%)也均要高于单独指标的诊断效能。结论:血清PCT联合乳酸对糖尿病酸中毒合并感染的诊断价值要高于二者单独的诊断效能。
Objective: To investigate the significance and value of serum procalcitonin (PCT) and lactate levels in patients with diabetic acidosis complicated with infection. Methods: Collecting 60 cases of all patients with diabetic acidosis who were hospitalized in emergency department of our hospital from February 2014 to June 2016 as an infection group, and 60 cases of patients with acidosis without concomitant diabetes mellitus were enrolled as non-infectious control. PCT and lactate levels were measured in patient sera, as well as ketone body, liver and renal function (ALT and AST, Scr and BUN), blood routine [WBC, neutrophil percentage]. Results: The levels of WBC, neutrophil, ketone body, AST and BUN in infected group were significantly higher than those in control group (P <0.05). The serum PCT and lactate levels in infected group were significantly higher than those in control group (P <0.05). The elevated serum PCT and lactate levels were the strongest risk predictors of comorbid diabetic acidosis with ORs of 3.114 and 2.072, respectively (P <0.05). Serum PCT alone had a lower area under the curve (AUC) of 0.875 (P = 0.001) for diagnosis of comorbid diabetic acidosis and a higher AUC than lactic acid of 0.759 (P = 0.003), but its diagnostic sensitivity (83.8%) was higher PCT (73.3%), whereas the PCT specificity (86.7%) was higher than that of lactic acid (71.7%). The AUC (0.881, P <0.001) , And its sensitivity (88.6%) and specificity (89.4%) were also higher than the diagnostic efficacy of individual indicators. Conclusion: The diagnostic value of serum PCT combined with lactic acid in patients with diabetic acidosis was higher than that of the two alone.