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目的探讨DKA患者血淀粉酶(AMS)升高的临床危险因素。方法选取263例DKA患者为研究对象,根据AMS水平分为正常组(DKA,n=188)和升高组(HAMS,n=75),HAMS组根据有无急性胰腺炎(AP)发生分出HAMS合并AP亚组(HAMS+AP,n=25),检测FPG、TG、AMS等指标。结果 HAMS组AMS升高发生率28.5%,AP发生率9.5%,其TG、FPG、HbA_1c、Na~+、血浆渗透压、BUN、Scr水平均高于DKA组(P<0.05或P<0.01);HAMS+AP亚组TG、FPG、血浆渗透压、BUN、CO_2结合力(CO_2CP)恢复正常时间均高于HAMS组(P<0.05或P<0.01)。相关分析显示,AMS升高与TG、FPG、Na~+、血浆渗透压、BUN均呈正相关(r=0.146、0.133、0.126、0.182、0.192,P<0.05或P<0.01)。Logistic二元回归分析显示,TG升高是DKA患者AMS升高的独立危险因素(OR1.244,P<0.01),是HAMS+AP的独立危险因素(OR 1.211,P<0.05)。结论 TG升高是DKA患者AMS升高的临床相关危险因素,亦是诱发AP的危险因素。本研究为DKA患者早期筛查AP提供了一定的理论依据。
Objective To investigate the clinical risk factors of elevated serum amylase (AMS) in patients with DKA. Methods Totally 263 DKA patients were divided into normal group (DKA, n = 188) and elevated group (HAMS, n = 75) according to AMS level. HAMS group was divided according to the presence or absence of acute pancreatitis (AP) HAMS combined with AP subgroup (HAMS + AP, n = 25), detection of FPG, TG, AMS and other indicators. Results The incidence of AMS in HAMS group was 28.5% and the incidence of AP was 9.5%. The levels of TG, FPG, HbA 1c, Na +, plasma osmolality, BUN and Scr in HAMS group were significantly higher than those in DKA group (P <0.05 or P <0.01) ; HAMS + AP subgroup TG, FPG, plasma osmolality, BUN, CO 2 CP (CO 2 CP) recovery time were higher than the HAMS group (P <0.05 or P <0.01). Correlation analysis showed that the increase of AMS was positively correlated with TG, FPG, Na ~ +, plasma osmotic pressure and BUN (r = 0.146,0.133,0.126,0.182,0.192, P <0.05 or P <0.01). Logistic regression analysis showed that elevated TG was an independent risk factor for AMS in patients with DKA (OR1.244, P <0.01), which was an independent risk factor for HAMS + AP (OR 1.211, P <0.05). Conclusion The elevated TG is a clinically relevant risk factor for AMS in DKA patients and is also a risk factor for inducing AP. This study provides some theoretical basis for early screen AP in patients with DKA.