A Study Of Peripheral Blood β-Hydroxybutyric Acid Detection In The Diagnosis And Treatment Of Diabetes And Diabetic Ketoacidosis

Background: In recent years，the number of diabetics increase every year，thereare around150million people with diabetes, the human living environment hasbecome increasingly complex, the diabetes will likely increase further. One of theacute complications with diabetes is diabetic ketoacidosis. And diabetic ketoacidosisis the most common and most serious, it is the main reason that leads to the death ofdiabetics. Abnormal blood sugar, body fat and metabolic disorders are in Diabeticketoacidosis(DKA) patients. Fat mobilization and decomposition was accelerated, alarge number of intrahepatic free fatty acids generate ketone bodies throughβ-oxidation, because of more than normal tissue oxidative capacity, so it leads toblood ketone body increased, acidosis is produced by large amounts of ketonesgathering. Blood sugar (GLu), urine ketone bodies, electrolyte, blood gas analysis,carbon dioxide combining power osmotic pressure were used mainly for detectionindicators of DKA diagnosis in the past.But those ways are lack of specificity. Toassist the doctors to understand accurately and timely the patient’s condition, a reliableand strong specificity indicator is needed. The main ingredient of the ketone bodies,β-hydroxybutyrate, becomes clinical research hotspot in field of diabetes and diabeticketoacidosis.Objcetive:(1) Explore the level of peripheral blood β-HBA and urine ketonebody in patients with diabetes and DKA.(2)Explore the level of peripheral bloodβ-HBA on diabetic patients after applied regulating blood sugar and symptomatictreatment; approach the level of peripheral blood β-HBA、urine ketone body and itsrelationship with blood sugar levels in DKA patients after treated with fluid replacementand regulating blood sugar.(3)To investigate clinical significance and sensitivity ofperipheral blood β-HBA in diabetes and DKA, and to compare with urine ketonebody which is the traditional test method. Methods: Collecting80cases of patients with DKA（DKA group）and diabeteswithout ketosis (NDK group) respectively. In NDK group, patients was giventreatment of regulating blood sugar, symptomatic and supportive treatment; patientsin DKA group was given fluid replacement, regulating blood sugar and supportivetreatment, they were all treated for7days. Detected β-HBA、urine ketone bodiesand glucose levels before and after the treatment in two groups.Result：(1) Before treatment, positive rate of peripheral blood β-HBA was higherthan urine ketone body in NDK group(p <0.05).(2) Before treatment, the levels ofperipheral blood β-HBA in DKA group were higher than those in NDK group(p <0.05), there was significant positive correlation between β-HBA concentration andblood glucose levels (r=0.578, p <0.01), but the level of urine ketone body andblood glucose had no correlation (r=0.186).(3) After treatment, urine ketone body isnegative in two groups. In DKA group, the levels of β-HBA were higher than those inNDK group(p <0.05).Conclusions:(1) In NDK group, positive rate of peripheral blood β-HBA washigher than urine ketone body which suggest that detecting β-HBA can help to treatpatients with high hyperketonemia early and avoid DKA.(2) Before the treatment, thelevels of peripheral blood β-HBA in DKA group were higher than those in NDKgroup; there was significant positive correlation between β-HBA concentration andblood glucose levels, but urine ketone body had no correlation, those which suggestβ-HBA can more effectively react the severity of disease than urine ketone body.(3)After treatment, two groups of patients’ urine ketone body were negative, but in DKAgroup, β-HBA levels were higher than those in NDK group, we knew peripheralblood β-HBA level can reflect accurately recovery of diabetes or DKA.