| Objective:To inquiry into the differential diagnostic indexes of newly diagnosed type 1 diabetic ketoacidosis (DKA) with stress hyperglycemia(SHG) in critical children patients.Methods:Thirty cases with DKA aged (6.5±3.6 )years and 20 critical cases with SHG patients aged ( 5.8±3.1 ) years were prospectively studied. Glycosylated hemoglobin( HbA1c), glycosylated serum protein(GSP), fasting blood glucose(FBG), carbon dioxide combining power(CO2-CP), anion gap(AG), fasting C -peptide(FCP), fasting insulin(FINS), insulin resistence index(IRI), cortisol(COR) and if insulin dependence were compared between DKA and SHG group. Thirty healthy children aged (6.1±3.4)years served as normal controls(C group).There were no difference among groups in age and gender, p>0.05.Results:(1)The concentrations of FBG were significantly higher in both DKA and SHG than the group C(P<0.001), and It was higher in group DKA than in group SHG(p<0.05).But there was a overlap of FBG between DKA and SHG at 95% confidence interval (CI).(2) The concentration of HbA1c in DKA was significantly higher than both group SHG and C (p<0.001).There was no significantly difference between group SHG and C(p>0.05).And there was no overlap of HbA1c between DKA and SHG at 95% CI. HbAlc>7.3% in DKA,and HbA1c <6.5% in SHG.(3) The concentration of GSP in group DKA was significantly higher than both group SHG and C. The concentration of GSP was significantly higher in group SHG than in group C, but there was no overlap of GSP between DKA and SHG at 95% CI. GSP>550μmol/L in DKA, and GSP (203μmol/L in SHG.(4) The concentrations of CO2-CP were significantly lower in both group DKA and SHG than in group C (p<0.001),and it was significantly lower in group DKA than in SHG (p<0.001) .But there was a overlap of CO2-CP between DKA and SHG at 95% CI.(5) The concentrations of AG were significantly higher both in group DKA and SHG than in group C, but there were no significantly difference between group DKA and SHG(p>0.05).(6) The concentration of FINS was significantly lower in group DKA than in both group SHG and C (p<0.001) . The concentration of FINS was significantly higher in group SHG than in group C (p<0.001), and there was no overlap of FINS between DKA and SHG at 95% CI. FINS<2.6U/L in DKA, and FINS>9.3U/L in SHG.(7) The concentration of FCP was significantly lower in group DKA than in both group SHG and C (p<0.001). The concentration of FCP was significantly higher in group SHG than in group C (p<0.001), and there was no overlap of FCP between DKA and SHG at 95% CI. FCP<0.16ng/ml in DKA, and FCP>0.9ng/ml in SHG.(8) The IRI in SHG group was significantly higher than in group C and DKA (p<0.001) , and there was no overlap of IRI between DKA and SHG at 95% CI. IRI<2.7mMU/L in DKA, and IRI>5.3 mMU/L in SHG.(9) The concentrations of COR were significantly higher both in group DKA and SHG than in group C (p<0.001) , but there were no significantly difference between group DKA and SHG(p>0.05). (10) The blood glucose easily control in group SHG after reducing the intravenous glucose infusion and insulin-controversary regulating hormones or short-term small dosage insulin transfusion, but the blood glucose control dependent on the insulin injection in group DKA and any dosage omitted would result in hyperglycemia.Conclusions:(1) The levels of FBG , AG and COR were elevated in both group DKA and SHG ;The levels of CO2-CP were decreased in both group DKA and SHG, So differential diagnosis are needed between group DKA and SHG in clinical.(2) The FCP , FINS, IRI,HbAlc, and GSP are simple and specific differencial indexs for differencial diagnosis between DKA and SHG. The FCP ,FINS and IRI were decreased significantly and the HbA1c and GSP were elevated significantly in DKA, but FCP ,FINS, and IRI were increased significantly , and the HbAlc<6.5% in SHG.(3) Whether depending on insulin treatment or not is a reconfirming index for differencial diagnosis between DKA and SHG. |
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