| 摘要: |
| ［摘要］ 目的 探讨血清β-羟丁酸（β-HB）、糖化血红蛋白（HbA1c）与糖尿病酮症酸中毒（DKA）并发脑水肿患儿发生认知功能障碍的关联性。方法 招募2020年3月至2023年3月唐山市中心医院收治的DKA合并脑水肿患儿148例。于患儿入院治疗后（生命体征稳定）采用韦氏儿童智力量表第四版（WISC-Ⅳ）对患儿的认知功能进行评估，依据评估结果将患儿分为认知障碍组（WISC-Ⅳ评分<80分，26例）和对照组（WISC-Ⅳ评分≥80分，122例）。比较两组血清β-HB、HbA1c水平及其他临床资料。通过Pearson相关分析血清β-HB、HbA1c与WISC-Ⅳ评分的相关性。采用多因素logistic回归分析DKA合并脑水肿患儿发生认知功能障碍的危险因素，并通过受试者工作特征（ROC）曲线评估血清β-HB、HbA1c水平预测DKA合并脑水肿患儿发生认知功能障碍的效能。结果 与对照组相比，认知障碍组空腹血糖（FPG）、乳酸（Lac）、总胆固醇（TC）、HbA1c及β-HB水平升高，血钠、血pH水平降低，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，血清β-HB、HbA1c水平与WISC-Ⅳ评分均呈负相关（r=-0.634，P<0.001；r=-0.590，P<0.001）。多因素logistic回归分析结果显示，较高的β-HB［OR（95%CI）=2.119（1.090～4.118）］、HbA1c［OR（95%CI）=2.423（1.083～5.423）］水平是患儿发生认知功能障碍的独立危险因素（P<0.05），较高血钠［OR（95%CI）=0.590（0.363～0.960）］水平是抑制认知功能障碍的独立保护因素（P<0.05）。ROC曲线分析结果显示，血清β-HB、HbA1c可有效预测DKA合并脑水肿患儿发生认知功能障碍（P<0.05），且两指标联合检测的效能［AUC（95%CI）=0.930（0.867～0.969）］较单项指标更优，灵敏度和特异度分别为88.46%、91.80%。结论 DKA合并脑水肿患儿血清β-HB、HbA1c水平升高，可预测DKA合并脑水肿患儿发生认知功能障碍的风险，有助于临床医师及早干预，改善患儿预后。 |
| 关键词: 糖尿病酮症酸中毒 脑水肿 认知功能 β-羟丁酸 糖化血红蛋白 |
| DOI：10.3969/j.issn.1674-3806.2025.07.15 |
| 分类号:R 587.2 |
| 基金项目:河北省医学科学研究课题计划（编号：20220717） |
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| Analysis on association of serum β-HB and HbA1c with occurrence of cognitive dysfunction in diabetic ketoacidosis pediatric patients complicated with cerebral edema |
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MI Yanru1, ZHANG Liguang2, FAN Aihong2
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1.Department of Pediatrics, Tangshan Central Hospital, Tangshan 063000, China; 2.Department of Pediatric Internal Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China
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| Abstract: |
| ［Abstract］ Objective To explore the association of serum beta-hydroxybutyrate(β-HB) and glycated hemoglobin(HbA1c) with occurrence of cognitive dysfunction in diabetic ketoacidosis(DKA) pediatric patients complicated with cerebral edema. Methods A total of 148 DKA pediatric patients complicated with cerebral edema who were admitted to Tangshan Central Hospital from March 2020 to March 2023 were recruited. After the pediatric patients were admitted to the hospital for treatment and their vital signs were stable, the cognitive function of the pediatric patients was evaluated by using Wechsler Intelligence Scale for Children, Fourth Edition(WISC-Ⅳ), and the pediatric patients were divided into cognitive dysfunction group(WISC-Ⅳ scores <80 points, 26 patients) and control group(WISC-Ⅳ scores ≥80 points, 122 patients) according to the evaluation results. The levels of serum β-HB and HbA1c, and the other clinical data were compared between the two groups. The correlation of serum β-HB and HbA1c with WISC-Ⅳ scores were analyzed by using Pearson correlation. Multivariate logistic regression was used to analyze the risk factors of cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema. The efficacy of serum β-HB and HbA1c levels in predicting cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema was evaluated by using receiver operating characteristic(ROC) curve. Results Compared with those in the control group, the levels of fasting plasma glucose(FPG), lactic acid(Lac), total cholesterol(TC), HbA1c and β-HB in the cognitive dysfunction group were increased, while the levels of blood sodium and blood pH in the cognitive dysfunction group were decreased, with statistically significant differences between the two groups(P<0.05). The results of Pearson correlation analysis showed that the levels of serum β-HB and HbA1c were negatively correlated with the WISC-Ⅳ scores(r=-0.634, P<0.001; r=-0.590, P<0.001). The results of multivariate logistic regression analysis showed that higher levels of β-Hb ［OR(95%CI)=2.119(1.090-4.118)］ and HbA1c［OR(95%CI)=2.423(1.083-5.423)］ were independent risk factors for cognitive dysfunction in the pediatric patients(P<0.05), while higher blood sodium level ［OR(95%CI)=0.590(0.363-0.960)］ was an independent protective factor for inhibiting cognitive dysfunction(P<0.05). The results of ROC curve analysis showed that serum β-Hb and HbA1c could effectively predict cognitive dysfunction in the DKA pediatric patients complicated with cerebral edema(P<0.05), and the predicting efficacy of the combined detection of the two indicators［AUC(95%CI)=0.930(0.867-0.969)］ was better than that of a single indicator, and the sensitivity and specificity were 88.46% and 91.80%, respectively. Conclusion The levels of serum β-HB and HbA1c are elevated in DKA pediatric patients complicated with cerebral edema, which can predict the risk of cognitive dysfunction in DKA pediatric patients complicated with cerebral edema. The prediction is helpful for clinicians to intervene early and improve the prognosis of the pediatric patients. |
| Key words: Diabetic ketoacidosis(DKA) Cerebral edema Cognitive function Beta-hydroxybutyrate(β-HB) Glycated hemoglobin(HbA1c) |
