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目的探讨非应激状态下住院2型糖尿病(T2DM)高血酮患者的临床特征。方法以入院随机末梢血酮是否≥0.6 mmol/L将2015-10-01至2016-06-30入住南京大学医学院附属鼓楼医院内分泌科134例非应激状态下入院随机血糖≥13.9 mmol/L的T2DM患者分为高血酮组(25例)和非高血酮组(109例)。比较两组一般情况、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、血清C肽、生化检查、甲状腺功能、骨代谢指标及入院前降糖药物使用情况。结果高血酮组较非高血酮组年龄轻、病程短、HbA1c及FBG高、餐后2 h C肽水平低、合并更多低血清游离T3,入院前应用胰岛素比例低,降糖药物种类少;年轻、短病程、高HbA1c、低血清游离T3为住院T2DM患者高血酮独立危险因素。结论非应激状态下住院T2DM患者酮症不少见,加强T2DM筛查及病程短患者血糖控制,可避免严重高血糖及酮症,血酮检测有助于发现酮症,避免酮症酸中毒(DKA)发生。
Objective To investigate the clinical features of patients with type 2 diabetes (T2DM) hyperlipidemia in non-stressed state. Methods Randomized admission of blood serum in patients with ≥ 0.6 mmol / L 2015-10-01 to 2016-06-30 Hospitalization Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University Medical College 134 cases of non-stress admission random glucose ≥ 13.9 mmol / L Of T2DM patients were divided into high blood ketone group (25 cases) and non-high blood ketone group (109 cases). HbA1c, FBG, serum C-peptide, biochemical examination, thyroid function, bone metabolism index and the use of hypoglycemic agents before admission were compared between the two groups. Results Compared with non-hyperhidrosis group, the hyperlipidemia group was younger in age, shorter in duration, higher in HbA1c and FBG, lower in C peptide at 2 h postprandial, with more low serum free T3, low pre-admission insulin dosage, Less; young, short course, high HbA1c, low serum free T3 is an independent risk factor for hyperglycemia in inpatients with T2DM. Conclusions Ketosis is not uncommon in hospitalized patients with T2DM in non-stressed state. It is suggested that T2DM screening and glycemic control in patients with short duration of disease should be strengthened to avoid severe hyperglycemia and ketosis. Blood ketone test may help to detect ketosis and avoid ketoacidosis DKA) occurs.