白蛋白校正阴离子间隙对老年糖尿病酮症酸中毒患者预后的预测价值 ^*

Prognostic value of albumin corrected anion gap in elderly patients with diabetic ketoacidosis

摘要

目的 探究白蛋白校正阴离子间隙 (ACAG) 对老年糖尿病酮症酸中毒患者预后的预测价值。方法 选择 2022 年 5 月—2024 年 6 月中国医科大学附属盛京医院收治的 100 例老年糖尿病酮症酸中毒患者作为研究对象。收集患者的性别、年龄、体质量、身高、糖尿病病程、糖尿病分型、阴离子间隙 (AG)、白蛋白 (Alb)、糖化血红蛋白 (HbA1c)、空腹血糖 (FBG)、血酮体 (BK)、尿酮体 (UK)、动脉血 pH 值、血碳酸氢根 (HCO _3-)、中性粒细胞 (NEU) 和淋巴细胞 (LYM) 指标, 计算体质量指数、ACAG 和中性粒细胞与淋巴细胞比值 (NLR)。对 100 例患者连续随访 28 d, 依据患者预后生存状况, 将其划分为生存组 (71 例) 与死亡组 (29 例)。通过单因素与多因素 logistic 回归模型分析, 探究老年糖尿病酮症酸中毒患者预后不佳的风险因素, 并运用 ROC 曲线评估 ACAG 对预后不良的预测效能。结果 单因素分析结果显示, 死亡组 AG、ACAG、HbA1c、NEU、NLR 水平均高于存活组 (P<0.05), Alb、LYM 水平低于存活组 (P<0.05); 多因素 logistic 回归分析结果显示, AG、ACAG、HbA1c 是预后不良的独立危险因素 (P<0.05), 而 Alb 是其保护因素 (P<0.05); ROC 曲线分析显示, AG、Alb、ACAG 和 HbA1c 预测老年糖尿病酮症酸中毒患者预后不良的曲线下面积分别为 0.757、0.765、0.814、0.771, ACAG 的预测效能最高。结论 ACAG 对老年糖尿病酮症酸中毒患者预后的预测具有较高价值, 建议在临床推广使用。

Abstract

Objective To explore the predictive value of albumin corrected anion gap (ACAG) for the prognosis of elderly patients with diabetic ketoacidosis. Methods A total of 100 elderly patients with diabetic ketoacidosis admitted to Shengjing Hospital Affiliated to China Medical University from May 2022 to June 2024 were selected as the research subjects. The gender, age, body mass, height, duration of diabetes, type of diabetes, anion gap (AG), albumin (Alb), glycated hemoglobin (HbA1c), fasting blood glucose (FBG), blood ketone bodies (BK), urine ketone bodies (UK), arterial blood pH value, blood bicarbonate (HCO _3-), and neutrophils (NEU) and lymphocytes (LYM) of 100 patients were collected. The levels of body mass index, the ACAG and neutrophil-to-lymphocyte ratio (NLR) were calculated. One hundred patients were followed up continuously for 28 days. According to the prognosis and survival status of the patients, they were divided into the survival group (71 cases) and the death group (29 cases). Through univariate and multivariate logistic regression analyses, the risk factors for poor prognosis in elderly patients with diabetic ketoacidosis were explored, and the predictive efficacy of ACAG for poor prognosis was evaluated using the receiver operating characteristic curve (ROC) curve. Results The results of univariate analysis showed that the levels of AG, ACAG, HbA1c, NEU and NLR in the death group were all higher than those in the survival group (P<0.05), and the levels of Alb and LYM were lower than those in the survival group (P<0.05). The results of multivariate logistic regression analysis showed that the levels of AG, ACAG, and HbA1c were risk factors for poor prognosis (P<0.05), while the level of Alb was a protective factor (P<0.05). ROC curve analysis showed that the areas under the curve of AG, Alb, ACAG and HbA1c for predicting poor prognosis in elderly diabetic ketoacidosis patients were 0.757, 0.765, 0.814 and 0.771, respectively, ACAG had the highest predictive power. Conclusion ACAG has a high value in predicting the prognosis of elderly patients with diabetic ketoacidosis and is recommended for clinical promotion and application.

关键词

白蛋白校正阴离子间隙 / 糖尿病 / 酮症酸中毒 / 预后 / 预测价值

Key words

Albumin corrected anion gap / Diabetic / Ketoacidosis / Prognosis / Predictive value

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基金资助

^*国家自然科学基金资助项目(81072182)