The Correlation between Myocardial Enzymes and the Severity of Ketoacidosis in Children with Type 1 Diabetes
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摘要:
目的 探究心肌酶谱与儿童1型糖尿病酮症酸中毒（DKA）病情严重程度的相关性。 方法 选取安徽省儿童医院2016年1月至2019年12月期间收治的30例儿童1型糖尿病DKA患儿作为研究对象，另选取同期1型糖尿病非DKA患儿20例作为对照组，分析心肌酶谱与疾病严重程度的相关性。 结果 DKA组患儿血清LDH、CK、CK-MB、AST水平明显高于对照组（P < 0.05）。血清CK、LDH、CK-MB、AST对1型糖尿病患者DKA均具有一定的预测价值，ROC曲线下面积AUC分别为0.990（95%CI：0.969～1.011， P < 0.001）、0.891（95%CI：0.805～0.977， P < 0.001）、0.843（95%CI：0.731～0.956， P < 0.001）、0.763（95%CI：0.622～0.905， P < 0.001）。DKA组患儿LDH、CK水平随着病情加重逐级上升（F = 39.251，11.458；P < 0.001，< 0.001）。与缓解期比较，DKA患儿急性期血清LDH、CK、CK-MB、AST水平均升高，差异有统计学意义（P < 0.05）。Spearman相关分析结果显示，CK、LDH与DKA严重程度呈正相关（r = 0.933、0.793，P < 0.0001、< 0.0001）。 结论 随病情进展，DKA患儿心肌酶逐渐升高，动态监测患儿心肌酶指标变化，对于病情评估及治疗具有重大意义。 Abstract:Objective To investigate the correlation between myocardial enzymes and the severity of type 1 diabetic ketoacidosis in children. Methods From January 2016 to December 2019, thirty children with type 1 diabetes and DKA treated in Anhui Provincial Children's Hospital were selected as the research objects, and twenty children with type 1 diabetes and non-DKA during the same period were selected as the control group to analyze the correlation between myocardial enzymes and disease severity. Results The serum levels of LDH, CK, CK-MB and AST in children with DKA were significantly higher than those in the control group（all P < 0.05）. Serum CK, LDH, CK-MB, AST had certain predictive value for DKA in patients with type 1 diabetes, the area under the ROC curve AUC was 0.990（95%CI: 0.969～1.011）, 0.891（95%CI: 0.805～0.977）, 0.843（95%CI: 0.731～0.956）, 0.763（95%CI: 0.622～0.905）. The levels of LDH and CK in children with DKA increased gradually with the progression of the disease（F = 39.251, 11.458; P < 0.001, < 0.001）. Compared with the remission period, the serum levels of LDH, CK, CK-MB and AST in children with DKA increased during the acute phase, and the differences were statistically significant（all P < 0.05）. Multivariate Logistic regression analysis showed that CK and LDH were the independent risk factors for DKA（OR = 1.582, 1.651, P < 0.05）. Spearman correlation analysis showed that CK and LDH were positively correlated with the progression of DKA（r = 0.933, 0.793, P < 0.0001, < 0.0001）. Conclusion As the disease progresses, myocardial enzymes in patients with DKA gradually increase, and dynamic monitoring of changes in myocardial enzymes in patients is of great significance for the disease evaluation and treatment. -
Key words:
- Myocardial enzymes /
- Diabetic ketoacidosis /
- Type 1 diabetes /
- Condition /
- Correlation
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图 1 血清CK、LDH、CK-MB、AST预测1型糖尿病患者DKA的ROC曲线
Figure 1. ROC curve of serum CK，LDH，CK-MB and AST to predict DKA of type 1 diabetes
图 2 CK、LDH与DKA严重程度相关性分析（轻度、中度、重度分别用1、2、3表示）
Figure 2. Analysis of the correlation between DKA severity and serum CK and LDH（mild，moderate and severe indicated with 1，2 and 3 respectively）
表 1 两组对象一般资料、心肌酶水平的比较（
$\bar x \pm s$ ）Table 1. Comparation of basic information and myocardial enzymes between the two groups（
$\bar x \pm s$ ）参数 DKA组（n = 30） 对照组（n = 20） χ2/t P 年龄（岁） 10.0 ± 2.3 12.1 ± 0.4 0.089 0.839 性别[（n），%] 男 16（53.33） 9（45.00） 0.3333 0.564 女 14（46.67） 11（55.00） BMI（kg/m2） 16.12 ± 2.87 17.67 ± 2.46 1.915 0.384 LDH（U/L） 230.01 ± 70.01 167.73 ± 2.38 7.518 0.023* CK（U/L） 542.04 ± 96.03 88.23 ± 18.03 7.373 0.025* CK-MB（U/L） 48.23 ± 4.91 24.34 ± 2.43 9.600 0.008* AST（U/L） 69.09 ± 6.09 33.09 ± 5.89 9.078 0.011* 两组比较，*P < 0.05。 
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表 2 急性期不同病情程度的DKA组患儿血清中心肌酶水平的比较（
$\bar x \pm s$ ）Table 2. Comparation of serum levels of myocardial enzymes in acute DKA phase children with different disease severity（
$\bar x \pm s$ ）DKA分级 n LDH（U/L） CK（U/L） CK-MB（U/L） AST（U/L） 轻度 13 217.75 ± 24.37 400.35 ± 12.17 30.03 ± 4.91 44.65 ± 6.19 中度 10 235.49 ± 17.54 569.49 ± 8.27 69.98 ± 5.63 89.56 ± 6.32 重度 7 375.32 ± 18.59 690.26 ± 6.84 47.98 ± 5.63 68.34 ± 5.34 F − 39.251 11.458 1.79 1.890 P − < 0.001* < 0.001* 0.173 0.169
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表 3 DKA组患儿急性期和缓解期心肌酶谱对比（
$\bar x \pm s$ ）Table 3. Comparation of serum myocardial enzymes in DKA children between acute and relieving stages（
$\bar x \pm s$ ）时间 LDH（U/L） CK（U/L） CK-MB（U/L） AST（U/L） 急性期 230.01 ± 70.01 542.04 ± 96.03 48.23 ± 4.91 69.09 ± 6.09 缓解期 210.01 ± 67.34 305.38 ± 75.55 26.13 ± 4.54 36.78 ± 4.45 t 27.478 41.374 16.322 10.345 P 0.015* < 0.001* < 0.001* 0.021*
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