1型糖尿病伴糖尿病酮症酸中毒患儿发生急性肾损伤的临床研究

A clinical study of acute kidney injury in children with type 1 diabetes and diabetic ketoacidosis

摘要:

目的 评估1型糖尿病伴糖尿病酮症酸中毒（diabetic ketoacidosis，DKA）患儿发生急性肾损伤（acute kidney injury，AKI）的情况，探讨导致DKA患儿发生AKI的可能潜在因素。 方法 回顾性将2018年1月1日至2020年12月31日在南京医科大学附属儿童医院就诊的45例1型糖尿病伴DKA患儿，按照入院时是否合并AKI分为无AKI组（n=37）和合并AKI组（n=8）。收集两组患儿社会人口学资料，入院时的体检数据，包括身高、体重、血压和心率等，采用化学发光微粒免疫分析法测定患儿入院及出院时血肌酐和尿素氮等指标水平。采用多因素logistic回归模型分析1型糖尿病伴DKA患儿发生AKI的影响因素。 结果 45例患儿确诊中位年龄为9.2岁，8例（18%）入院时合并AKI的患儿中，6例为1期AKI，2例为3期AKI。血校正钠水平升高与1型糖尿病伴DKA患儿发生AKI密切相关（P<0.05），而入院时较高的胰岛素水平则不易发生AKI（P<0.05）。 结论 1型糖尿病伴DKA患儿AKI的发生率较高，临床上应积极纠正DKA，尽快控制血糖，并定期对这部分儿童病例进行肾功能复查和随访。

Abstract:

Objective To investigate the incidence rate of acute kidney injury (AKI) in children with type 1 diabetes and diabetic ketoacidosis (DKA) and the risk factors for AKI in children with DKA. Methods A retrospective analysis was performed on 45 children with type 1 diabetes and DKA who attended Children's Hospital of Nanjing Medical University from 2018 to 2020. According to the presence or absence of AKI on admission, they were divided into two groups: non-AKI (n=37) and AKI (n=8). Socio-demographic data and physical examination data on admission were collected, including height, weight, blood pressure, and heart rate. Chemiluminescence particle immunoassay was used to determine the levels of serum creatinine and blood urea nitrogen on admission and at discharge. The multivariate logistic regression model was used to assess the risk factors for AKI in children with type 1 diabetes and DKA. Results The 45 children had a median age of 9.2 years at diagnosis. Among the 8 children (18%) with AKI on admission, 6 had stage 1 AKI and 2 had stage 3 AKI. An increase in corrected serum sodium level was an independent risk factor for AKI in children with type 1 diabetes and DKA (P<0.05), and a relatively high insulin level on admission was an independent protective factor against AKI (P<0.05). Conclusions There is a high incidence rate of AKI in children with type 1 diabetes and DKA. It is important to correct DKA actively, control blood glucose in time, and perform renal function tests and follow-up regularly in such children.