J INTERN MED:酸抑制是否与糖尿病酮症酸中毒患者住院时间延长有关?

2022-02-26 MedSci原创 MedSci原创

研究人员发现艰难梭菌和肺炎可预测糖尿病酮症酸中毒合并消化性溃疡病患者住院时间延长,这暗示酸抑制可能在延长此类患者的住院时间中发挥作用。

糖尿病酮症酸中毒患者表现为血清低碳酸氢盐(HCO3-),其水平升高至≥15mEq/L被认为是糖尿病酮症酸中毒消退的标准之一。质子泵抑制剂(PPI)和组胺-2受体拮抗剂(H2RAs)均抑制胃壁细胞中H+/K+ATP酶的下游功能,从而减少HCO3-分泌到血液中。

近日,内科学领域权威杂志Journal of Internal Medicine上发表一篇研究文章,研究人员旨在验证这样的假设,即服用抑酸药物的糖尿病酮症酸中毒患者血清HCO3-可能延迟升高至>15mEq/L的标准,这可能导致住院时间增加,并试图比较此类患者的结果。为简单起见,在本研究中,需要抑酸的疾病被归类为消化性溃疡病。

这是一项回顾性研究,研究人员使用采用国际疾病分类(ICD-10)代码从全国住院患者样本中确定初步诊断为糖尿病酮症酸中毒的成年患者,并使用STATA进行分析,使用Fisher精确检验比较比例,使用student-t检验比较连续变量。研究人员使用倾向匹配、多变量Logistic和线性回归分析调整混杂变量。

患有消化性溃疡病的糖尿病酮症酸中毒患者调整后住院时间、ICU入院率和总住院费用更高。两组的死亡率和发病率指标相似。研究人员发现独立于住院时间增加的预测因子变量包括营养不良、艰难梭菌感染、肺炎、GCS评分3-8分和较高的Charlson合并症评分。

由此可见,研究人员发现艰难梭菌和肺炎可预测糖尿病酮症酸中毒合并消化性溃疡病患者住院时间延长,这暗示酸抑制可能在延长此类患者的住院时间中发挥作用。然而,需要进一步的研究来评估较少的HCO3-生成对住院时间的影响。

原始出处:

Umer Farooq,et al.Is acid suppression associated with the increased length of stay in diabetic ketoacidosis patients? A nationwide analysis.Journal of Internal Medicine.2022.https://onlinelibrary.wiley.com/doi/10.1111/joim.13466

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href='/topic/show?id=d0db264464a' target=_blank style='color:#2F92EE;'>#住院时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26446, encryptionId=d0db264464a, topicName=住院时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfbf2593024, createdName=crystal0563, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611475, encodeId=45cd16114e56a, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1676184, encodeId=3ff516e6184e3, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Tue Oct 11 23:41:47 CST 2022, time=2022-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967147, encodeId=5d8e196e14765, content=<a href='/topic/show?id=d7709560138' target=_blank style='color:#2F92EE;'>#酸抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95601, encryptionId=d7709560138, topicName=酸抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de89102, 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encryptionId=862b9553521, topicName=酮症酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6262500044, createdName=1249862am72(暂无昵称), createdTime=Fri Jun 03 07:41:47 CST 2022, time=2022-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1288697, encodeId=8e48128869ef8, content=<a href='/topic/show?id=b969e679974' target=_blank style='color:#2F92EE;'>#糖尿病酮症酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76799, encryptionId=b969e679974, topicName=糖尿病酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8346212, createdName=respect, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319154, encodeId=f6db1319154f1, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346140, encodeId=13ae1346140d8, content=<a href='/topic/show?id=ecbb9553661' target=_blank style='color:#2F92EE;'>#酮症酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95536, encryptionId=ecbb9553661, topicName=酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=wgsun, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407147, encodeId=2833140e147cb, content=<a href='/topic/show?id=d0db264464a' target=_blank style='color:#2F92EE;'>#住院时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26446, encryptionId=d0db264464a, topicName=住院时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfbf2593024, createdName=crystal0563, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611475, encodeId=45cd16114e56a, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1676184, encodeId=3ff516e6184e3, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Tue Oct 11 23:41:47 CST 2022, time=2022-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967147, encodeId=5d8e196e14765, content=<a href='/topic/show?id=d7709560138' target=_blank style='color:#2F92EE;'>#酸抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95601, encryptionId=d7709560138, topicName=酸抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de89102, 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objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346140, encodeId=13ae1346140d8, content=<a href='/topic/show?id=ecbb9553661' target=_blank style='color:#2F92EE;'>#酮症酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95536, encryptionId=ecbb9553661, topicName=酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=wgsun, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407147, encodeId=2833140e147cb, content=<a href='/topic/show?id=d0db264464a' target=_blank style='color:#2F92EE;'>#住院时间#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26446, encryptionId=d0db264464a, topicName=住院时间)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfbf2593024, createdName=crystal0563, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1611475, encodeId=45cd16114e56a, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Mon Feb 28 13:41:47 CST 2022, time=2022-02-28, status=1, ipAttribution=)]
    2022-02-28 mashirong
  7. [GetPortalCommentsPageByObjectIdResponse(id=1676184, encodeId=3ff516e6184e3, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Tue Oct 11 23:41:47 CST 2022, time=2022-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1967147, encodeId=5d8e196e14765, content=<a href='/topic/show?id=d7709560138' target=_blank style='color:#2F92EE;'>#酸抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95601, encryptionId=d7709560138, topicName=酸抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de89102, 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time=2022-02-28, status=1, ipAttribution=)]
  8. 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