CAJ | 학술논문

目的：探讨血β-羟丁酸和尿酮在糖尿病酮症(DK)诊断中的意义。方法在末梢血糖>13.9 mmol/L的糖尿病患者中，同步检测末梢血β-羟丁酸和尿酮。结果(1)在81例糖尿病血糖>13.9 mmol/L的患者中，DK的发生率为13.58%，糖尿病酮症酸中毒(DKA)的发生率为9.88%。(2)末梢血糖与末梢血β-羟丁酸呈正相关(r=0.330，P=0.003)，与尿酮无相关性。(3)末梢血β-羟丁酸与尿酮呈正相关(r=0.516，P=0.000)。(4)在DK或DKA患者中，5.26%(1/19)的患者尿酮(-)或(+-)，36.84%(7/19)的患者血β-羟丁酸<1 mmol/L。(5)当以尿酮为标准诊断DK时，末梢血β-羟丁酸的切点值为0.35 mmol/L。结论单用尿酮或血β-羟丁酸诊断酮症均可能发生漏诊，联合监测血β-羟丁酸和尿酮可以减少酮症的漏诊率。当血β-羟丁酸轻度升高(≥0.35 mmol/L)时可能已经存在尿酮症，此时应该检测尿酮以避免漏诊DK。
목적：탐토혈β-간정산화뇨동재당뇨병동증(DK)진단중적의의。방법재말소혈당>13.9 mmol/L적당뇨병환자중，동보검측말소혈β-간정산화뇨동。결과(1)재81례당뇨병혈당>13.9 mmol/L적환자중，DK적발생솔위13.58%，당뇨병동증산중독(DKA)적발생솔위9.88%。(2)말소혈당여말소혈β-간정산정정상관(r=0.330，P=0.003)，여뇨동무상관성。(3)말소혈β-간정산여뇨동정정상관(r=0.516，P=0.000)。(4)재DK혹DKA환자중，5.26%(1/19)적환자뇨동(-)혹(+-)，36.84%(7/19)적환자혈β-간정산<1 mmol/L。(5)당이뇨동위표준진단DK시，말소혈β-간정산적절점치위0.35 mmol/L。결론단용뇨동혹혈β-간정산진단동증균가능발생루진，연합감측혈β-간정산화뇨동가이감소동증적루진솔。당혈β-간정산경도승고(≥0.35 mmol/L)시가능이경존재뇨동증，차시응해검측뇨동이피면루진DK。
Objcetive To investigate the relationship between blood β-hydroxybutyric acid and urine ketone in the di-agnosis of diabetic ketosis (DK). Methods Peripheral blood β-hydroxybutyric acid and urine ketone were detected when the peripheral blood glucose was more than 13.9 mmol/L in patients with diabetes. Results (1) In 81 diabetes pa-tients with blood glucose more than 13.9 mmol/L, the incidence of DK was 13.58% and the incidence of diabetic ke-toacidosis (DKA) was 9.88%. (2) The peripheral blood glucose was positively correlated with β-hydroxybutyric acid (r=0.330, P=0.003), but it was not correlated with urine ketone. (3) The peripheral blood β-hydroxybutyric acid was posi-tively correlated with urine ketone (r=0.516, P=0.000). (4) In patients with DK or DKA, 5.26%(1/19) of those were with urine ketone(-) or (+-), whereas 36.84% (7/19) of those were with blood β-hydroxybutyric acid less than 1 mmol/L. (5) When urine ketone was used as the reference test for diagnosis of DK, the optimal value of blood β-hydroxybutyric acid was 0.35 mmol/L. Conclusion For missed diagnosis of DK may be happend if blood β-hydroxybutyric acid or urine ketone is used alone, the co-monitoring of blood β-hydroxybutyric acid and urine ketone can reduce the inci-dence of missed diagnosis of DK. The urine ketosis may have existed when the blood β-hydroxybutyric acid is slightly elevated (≥0.35 mmol/L). In the situation, the urine ketone should be tested in order to avoid missed diagnosis of DK.