The early warning significance of cytokines in children with type 1 diabetic ketoacidosis complicated with cerebral edema

Abstract Objective To explore the clinical significance of cytokines in children with type 1 diabetic ketoacidosis complicated with cerebral edema, and to provide early warning indicators for type 1 diabetic ketoacidosis complicated with cerebral edema. Methods A total of 73 children with diabetic ketoacidosis ( DKA ) aged 1-15 years old who were hospitalized in the Department of Endocrinology from January 2017 to January 2022 were selected, including 48 children in the simple DKA group and 25 children in the DKACE group. The blood gas analysis, electrolyte, white blood cell count on admission, C-reactive protein, interleukin-1, interleukin-2, interleukin-4, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-α, interferon-γ, interleukin-2 receptor were compared between the two groups, and the differences between the two groups were analyzed. Results The results of univariate analysis showed that the levels of IL-2, IL-4, IL-6, IL-10, TNF-α, IL-2R, blood glucose, urea nitrogen and serum creatinine in DKACE group were higher than those in DKA group ( P <0.05 ) and higher than those in DKA group ( P < 0.05 ), and the PH value,PaCO2, HCO3-and K + were lower than those in DKA group ( P < 0.05 ). ROC curve analysis showed that the area under the curve of IL-4 combined with blood glucose detection was 0.908, and the combination of the two detection indexes could improve the sensitivity or specificity compared with the single detection index. The sensitivity of IL-6 combined with blood glucose detection for DKACE was 96 %, and the specificity was 87.5 %. Conclusion ( 1 ) Blood glucose, PH value, HCO3-, urea nitrogen, serum creatinine, IL-2, IL-4, IL-6, IL-10, TNF-α, IL-2R can be used as early warning indicators of DKACE. ( 2 ) The combination of the two detection indicators can improve the sensitivity or specificity compared with the single detection index, and provide the basis for the early identification and early treatment of DKACE.

摘要 目标：探究细胞因子在1型糖尿病酮症酸中毒合并脑水肿儿童中的临床意义，并为1型糖尿病酮症酸中毒合并脑水肿的早期预警指标提供依据。方法：选取2017年1月至2022年1月期间在内分泌科住院的73名1-15岁糖尿病酮症酸中毒（DKA）儿童，包括48名单纯DKA组和25名DKACE组儿童。对比两组儿童的入院时血气分析、电解质、白细胞计数、C反应蛋白、白细胞介素-1、白细胞介素-2、白细胞介素-4、白细胞介素-6、白细胞介素-8、白细胞介素-10、肿瘤坏死因子-α、干扰素-γ、白细胞介素-2受体水平，并分析两组之间的差异。结果：单因素分析结果显示，DKACE组IL-2、IL-4、IL-6、IL-10、TNF-α、IL-2R、血糖、尿素氮和血清肌酐水平均高于DKA组（P<0.05），且PH值、PaCO2、HCO3-和K+均低于DKA组（P<0.05）。ROC曲线分析显示，IL-4联合血糖检测的曲线下面积为0.908，两种检测指标的联合使用相较于单一指标检测能够提高灵敏度或特异性。IL-6联合血糖检测对DKACE的灵敏度为96%，特异性为87.5%。结论：1）血糖、PH值、HCO3-、尿素氮、血清肌酐、IL-2、IL-4、IL-6、IL-10、TNF-α、IL-2R可作为DKACE的早期预警指标。2）两种检测指标的联合使用相较于单一指标检测，可以提高灵敏度或特异性，并为DKACE的早期识别及早期治疗提供依据。