Study On The Clinical Application Value Of Blood Ketone Level In Senile Diabetic Ketosis

Objective:Through the respective analysis of senile diabeticketoacidosis and ketoacidosis in the last 4years in the second hospital of Jilin University.To explore the value of blood ketone detection in the clinical application of senile diabetic ketosis and clarify the importance of blood ketone detection.Methods:248 cases of diabetes mellitus with or without diabetic ketone(including diabetic ketoacidosis)elderly patients(aged 60 or over),who were performed blood ketone,urine ketone,blood sugar test and were hospitalized at the Second Hospital of the University of Jilin from January 2014 to September 2017.Divide the above patients into 2 group,the elderly diabetic ketosis group(elderly DK group,including ketoacidosis),the elderly diabetic non-ketosis group.The changes of blood ketone,blood sugar and urine ketone before and after treatment were compared between the two groups.To analyze the difference of the above three indexes before and after treatment in senile diabetic ketosis.Analyzing the correlation the above three indexes in elderly patients with DK group,and to find out whether there was any correlation between the three indexes.The changes of blood ketone,blood sugar and urine ketone in the two groups were monitored,and the time needed to restore normal the above indexes were compared and analyzed.At the same time,the present clinical value of blood ketone was 0.3 mmol/L,which means diabetic ketosis.In edition 8,the science diagnosed the blood ketone ≥1 mmol/L as high blood ketone and ≥3 mmol/L was DKA.To compare and analyze the clinical manifestation of the three subgroups and the group of senile diabetes mellitus.Finally,the best tangent value of blood ketone in the diagnosis of senile diabetic ketone was found by using the working characteristic curve(ROC curve).Results:1)Comparison of general data(including age,sex,BMI),there was no statistically significant difference between the DK group and the non-ketone group of diabetes mellitus.2)There were significant difference in blood ketone,blood sugar and urine ketone positive rate before and after treatment in elderly DK group,before was higher than after treatment.There were significant difference of the above three indexes between the DK group and the non-ketone group of diabetes mellitus,P<0.05.The DK group was higher than the non-ketone group of diabetes mellitus.There was no significant difference between the two groups after treatment(P<0.05).3)The positive correlation between blood ketone and blood sugar in elderly DK group(r=0.447,P<0.05),there was positive correlation between blood ketone and urine ketone(r=0.450,P<0.05),urine ketone and blood sugar(r=0.325,P < 0.05).4)The time of restoration of blood ketone,blood sugar and urine ketone in elderly patients with DK group was different,blood ketones were used faster than others,and urine ketones were used faster than blood sugar.5)There was no significant difference between the blood ketone value ≥0.3mmol/L and the blood ketone value of ≥1mmol/L in elderly DK group.But there was significant difference between the blood ketone value ≥0.3mmol/L and the blood ketone value of ≥3mmol/L,and the blood ketone value ≥3mmol/L and the blood ketone value of ≥1mmol /L was have significant difference.There was no statistically significant difference between the DK group who blood ketone value of ≥0.3mmol /L and the non-ketone group of diabetes mellitus.But there was significant difference in blood ketosis ≥1mmol/L and ≥3mmol/L between their.6)The best tangent value for the diagnosis of senile diabetic ketosis was 0.85mmol/L,sensitivity 71.8%,specificity 67.7%,area under the curve was 0.725.Conclusion:Before treatment,blood ketone,blood sugar and urine ketone positive rate in senile diabetic ketosis patients was higher than that in elderly diadebic non-ketosis patients,declining after treatment.There is a positive correlation between blood ketone,blood sugar and urine ketone in senile diabetic ketosis patients.It can be diagnosed in coordination.The recovery time of blood ketone in senile diabetic ketosis was faster than that of blood sugar and urine ketone.Using blood ketone as the main test index can avoid excessive medical treatment and reduce hospitalization cost.The clinical manifestation of senile diabetic ketosis was obvious at ≥3mmol/L,but that not obvious at<3mmol/L.At<1mmol /L,there was no obvious difference with non-ketotic patients,which could lead to missed diagnosis.The best tangent value for the diagnosis of senile diabetic ketosis was 0.85mmol/L.