合并糖尿病酮症酸中毒的老年2型糖尿病患者饮食管理预后情况分析

Analysis of prognosis of elderly patients with type 2 diabetes mellitus complicated with diabetes ketoacidosis receiving dietary management

中文关键词: 老年  糖尿病酮症酸中毒  2型糖尿病  饮食管理  炎症  糖代谢  预后评估

英文关键词: elderly  diabetic ketoacidosis  type 2 diabetes mellitus  dietary management  inflammation  glycome-tabolism  prognostic assessment

中文摘要:

      目的 探究合并糖尿病酮症酸中毒(DKA)的老年2型糖尿病(T2DM)患者外周血炎症指标及血糖水平与饮食管理后疗效的相关性,旨在为其临床诊治和疗效判断提供依据.方法 回顾性分析2021年12月-2023年12月收治于空军军医大学第一附属医院合并DKA的160例老年T2DM患者的临床资料,所有患者均接受饮食管理.根据患者治疗2个月内出现严重并发症及生存情况划分为预后良好组(n=120)和预后不良组(n=40).观察并比较2组一般临床资料(年龄、性别、BMI、高血压患病情况、运动习惯、吸烟史、饮酒史)、外周血炎症指标(NLR、PLR、LMR)值及糖代谢相关指标(FBG、HbA1c、2hBG)值.采用单因素、多因素Logistic回归分析方法,筛选合并DKA的老年T2DM患者预后不良的独立危险因素;通过受试者工作曲线(ROC)分析各因素对患者预后不良的独立预测价值.结果 预后不良组的平均BMI、NLR、PLR、HbA1c、FBG、2 hBG水平均高于预后良好组(P＜0.05),平均LMR水平低于预后良好组(P＜0.05);单因素及多因素Logistic回归分析发现,合并DKA的老年T2DM患者NLR、PLR、HbA1c、FBG、2 hBG较高均为饮食管理后预后不良的独立危险因素(P＜0.05);ROC分析表明,NLR、PLR、HbA1c、FBG、2 hBG独立预测的曲线下面积(AUC)均＞0.700,均具有较高独立预测效能.结论 外周血炎症指标异常及糖代谢持续紊乱均可能是影响合并DKA的老年T2DM患者饮食管理后疗效的重要危险因素,持续监测患者相关指标变化对判断患者预后具有一定的临床意义.

英文摘要:

      Objective To explore the relationship among inflammatory marker in peripheral blood,blood glucose level and the therapeutic effect of dietary management in elderly type 2 diabetes(T2DM)patients complicated with diabetic ketoaci-dosis(DKA),and provide a basis for clinical diagnosis,treatment and therapeutic effect judgment.Methods The clinical da-ta of 160 elderly T2DM patients with DKA admitted to First Affiliated Hospital of Air Force Military Medical University from December 2021 to December 2023 were retrospectively analyzed.All patients received dietary management.According to the occurrence of serious complications and survival status within 2 months of treatment,they were divided into good prognosis group(n=120)and poor prognosis group(n=40).The general clinical data(age,gender,BMI,hypertension,exercise habits,smoking history,drinking history),peripheral blood inflammation indexes(NLR,PLR,LMR)and glycometabolism-related indexes(FBG,HbA1c,2 hBG)of the two groups were observed and compared.Univariate and multivariate logistic re-gression analysis were used to screen the independent risk factors for poor prognosis in elderly T2DM patients with DKA.The independent predictive value of each factor for poor prognosis was analyzed by receiver operating characteristic(ROC)curve.Results The mean levels of BMI,NLR,PLR,HbA1c,FBG and 2 hBG of the poor prognosis group were higher than those of the good prognosis group(P＜0.05),and the mean LMR level of the poor prognosis group was lower than that of the good prognosis group(P＜0.05).Univariate and multivariate logistic regression analysis showed that elevated levels of NLR,PLR,HbA1c,FBG and 2 hBG in elderly T2DM patients with DKA were independent risk factors for poor prognosis after dietary management(P＜0.05).ROC analysis showed that the area under the curve(AUC)independently predicted by NLR,PLR,HbA1c,FBG,and 2 hBG were all greater than 0.700,indicating high independent predictive ability.Conclusion Abnormal peripheral blood inflammatory indexes and persistent glucose metabolism disorders may be important risk factors affecting the therapeutic effect of dietary management in elderly T2DM patients with DKA.Therefore,continuous monitoring of changes in relevant indexes of patients has certain clinical significance in predicting their prognosis.