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        糖尿病酮癥酸中毒患者血清CA19—9水平的變化

        2014-10-20 05:09:56陸珣靚
        中國醫(yī)學(xué)創(chuàng)新 2014年28期
        關(guān)鍵詞:酮癥酸中毒胰腺

        陸珣靚

        【摘要】 目的:回顧性觀察糖尿病酮癥酸中毒患者血清CA19-9水平,分析糖尿病急性代謝紊亂狀態(tài)下CA19-9升高的特點(diǎn)。方法:選取糖尿病酮癥酸中毒患者73例和血糖控制差(糖化大于7.5%)的糖尿病非酮癥酸中毒患者209例,對(duì)其性別、年齡、糖尿病病程、體重指數(shù)、HbA1c、CA19-9水平進(jìn)行分析。結(jié)果:(1)酮癥酸中毒組平均CA19-9水平29.7(57.8~15.35)U/mL,顯著高于非酮癥酸中毒組10.1(19.65~5.40)U/mL,比較差異有統(tǒng)計(jì)學(xué)意義(P<0.01);前者CA19-9升高的比例為39.7%,而后者為7.7%(P<0.01),兩者比較差異有統(tǒng)計(jì)學(xué)意義。(2)CA19-9升高的45例患者中數(shù)值在200 U/mL以內(nèi)者占95.6%,其中10例患者病情糾正后復(fù)查CA19-9均呈下降趨勢(shì)。結(jié)論:糖尿病患者CA19-9水平在酮癥酸中毒狀態(tài)下較非酮癥酸中毒狀態(tài)下可更明顯升高。

        【關(guān)鍵詞】 糖抗原CA19-9; 糖尿病酮癥酸中毒

        The Alteration of Serum CA19-9 Levels in Patients with Diabetic Ketoacidosis/LU Xun-liang.//Medical Innovation of China,2014,11(28):016-018

        【Abstract】 Objective: To retrospectively observe the alteration of serum CA19-9 levels in patients with diabetic ketoacidosis (DKA) compared to diabetics without DKA. Method: Seventy-three patients with DKA(DKA group) and 209 diabetics under dissatisfied glucose control (non-DKA group, HbA1c>7.5%) were enrolled. Records of gender, age, diabetic duration, BMI, HbA1c, CA19-9 level were collected. The levels of serum CA19-9 were compared between the two groups. Result: (1) Average CA19-9 level was significantly higher in DKA group 29.7(57.8-15.35)U/mL than that in non-DKA group 10.1(19.65-5.40)U/mL (P<0.01), as well as the percentage of positive CA19-9 level (39.7% and 7.7%, P<0.01). (2) The abnormal values were in range of 37.1-674.5 U/mL, mainly distributed within 200 U/mL(95.6%). Conclusion: Slight to moderate elevations of CA19-9 levels are more frequently found in DKA patients than diabetics under poor glucose control, as well as significant higher levels.

        【Key words】 Carbohydrate antigen 19-9; Diabetic ketoacidosis

        First-authors address: The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China

        doi:10.3969/j.issn.1674-4985.2014.28.006

        糖尿病和腫瘤的關(guān)系近年來備受關(guān)注,尤其是糖尿病與胰腺癌之間的相互關(guān)系近年來成為研究熱點(diǎn)[1-2]。因此,對(duì)糖尿病患者進(jìn)行腫瘤標(biāo)志物檢測(cè)已成為常規(guī)篩查手段。糖類抗原CA19-9(CA19-9)是臨床最常用的腫瘤標(biāo)志物之一,它對(duì)胰腺癌診斷的特異性和敏感性均超過70%,但由于它也可以在很多非腫瘤性疾病中升高[3-5],包括肝硬化、急慢性肝炎、膽道梗阻、某些甲狀腺疾病、某些肺部良性疾病以及糖尿病,因此在臨床應(yīng)用中仍需結(jié)合病情分析其升高的原因。

        人們?cè)缇妥⒁獾紺A19-9水平在糖尿病患者中升高的現(xiàn)象,以往的研究報(bào)道已給出以下結(jié)論:糖尿病人群CA19-9水平高于正常健康人群;血糖控制欠佳糖尿病患者CA19-9水平高于血糖控制良好者;糖化血紅蛋白可能是影響因素[6-8]。在臨床工作中,筆者注意到糖尿病酮癥酸中毒患者似乎更易出現(xiàn)CA19-9升高的現(xiàn)象,而目前關(guān)于CA19-9在酮癥酸中毒狀態(tài)下升高情況的研究報(bào)道很少,為明確該急性代謝紊亂狀態(tài)是否影響了CA19-9水平,本研究通過回顧性觀察,并與血糖控制欠佳的非酮癥酸中毒患者比較,總結(jié)了酮癥酸中毒狀態(tài)下CA19-9水平升高的特點(diǎn)并嘗試解釋這些現(xiàn)象的可能原因。

        1 資料與方法

        1.1 一般資料 本研究入選浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院內(nèi)分泌科2008年1月-2010年12月因糖尿病酮癥酸中毒入住的患者73例(其中T1DM 39例,T2DM 34例,男46例,女27例),年齡15~84歲,平均(38.6±16.13)歲,病程1~10年,所觀察病例無昏迷,血?dú)鈖H為7.25~7.35,血酮體在入院2~48 h內(nèi)轉(zhuǎn)陰。另擇同期入住本科的血糖控制差(HbA1c>7.5%)的非酮癥酸中毒患者209例(其中T1DM 30例,T2DM 179例,男112例,女97例),年齡14~87歲,平均(54.86±15.58),病程1~10年。兩組患者性別、年齡、病程比較差異均無統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。所有入選患者排除以下情況:有腫瘤病史或在本次住院期間發(fā)現(xiàn)或高度懷疑腫瘤;急慢性胰腺炎;有胰腺手術(shù)和外傷史;有肝膽系統(tǒng)急性感染或膽道梗阻;急慢性活動(dòng)性肝炎;肝硬化;急慢性腎功能衰竭;存在多器官功能衰竭;伴有甲狀腺疾病。endprint

        1.2 方法 收集患者一般指標(biāo)如性別、年齡、體重指數(shù)(BMI)、糖尿病病程及實(shí)驗(yàn)室檢查指標(biāo)如糖化血紅蛋白、血清CA19-9水平(本實(shí)驗(yàn)室CA19-9的正常范圍為0~37 U/mL)。實(shí)驗(yàn)室指標(biāo)均為入院第2天采血標(biāo)本檢測(cè)結(jié)果。

        1.3 統(tǒng)計(jì)學(xué)處理 所有數(shù)據(jù)使用SPSS (PASW) 18.0軟件進(jìn)行分析,計(jì)量資料先進(jìn)行正態(tài)性檢驗(yàn),若資料符合正態(tài)分布或近似正態(tài)分布采用(x±s)表示,兩組均數(shù)比較采用t檢驗(yàn);若資料不符合正態(tài)分布,用中位數(shù)(四分位間距)表示,兩組比較采用秩和檢驗(yàn)。計(jì)數(shù)資料比較采用 字2檢驗(yàn)。P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

        2 結(jié)果

        2.1 兩組患者血清CA19-9、BMI、HbA1c水平比較 兩組患者體重指數(shù)(BMI)、HbA1c比較,差異無統(tǒng)計(jì)學(xué)意義;酮癥酸中毒組CA19-9水平顯著高于非酮癥酸中毒組(P<0.01),比較差異無統(tǒng)計(jì)學(xué)意義。見表1。

        2.2 兩組患者CA19-9升高情況比較 酮癥酸中毒組CA19-9升高29例,占39.7%,其余正常;非酮癥酸中毒組升高16例,占7.7%,其余正常。兩組比較,差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。

        2.3 兩組血清CA19-9水平升高數(shù)值分布范圍比較 兩組共45例患者CA19-9水平高于正常,非酮癥酸中毒組(16例)升高的CA19-9數(shù)值均在200 U/mL之內(nèi),酮癥酸中毒組(29例)除兩例外,其余患者CA19-9數(shù)值也分布于200 U/mL之內(nèi),即95.6%的患者升高都在200 U/L以內(nèi)。研究中觀察到的CA19-9最高水平為674.5 U/mL。這45例患者中僅有10例患者在酮癥酸中毒糾正后(入院后第4~10天)進(jìn)行了復(fù)查,結(jié)果顯示2例患者降至正常,其余8例均呈下降趨勢(shì)。

        3 討論

        本研究觀察到血清CA19-9升高在酮癥酸中毒患者中比血糖控制差的糖尿病非酮癥酸中毒患者中更為常見,且升高的程度更高。目前國內(nèi)外關(guān)于糖尿病與腫瘤標(biāo)志物的研究較多表明糖化血紅蛋白CA19-9水平的影響因素[9-11],但本研究中兩組間HbA1c差異無明顯統(tǒng)計(jì)學(xué)意義,故平均血糖水平的影響不能很好解釋該結(jié)論,而酮癥酸中毒狀態(tài)可能是CA19-9水平的另一影響因素。1991年Benhamou等[12]的研究給了我們重要啟示,該作者亦觀察到酮癥酸中毒患者CA19-9水平顯著高于血糖控制不佳的非酮癥患者,且他認(rèn)為CA19-9可以作為急性代謝紊亂狀態(tài)下胰腺外分泌腺功能受損的反映。本研究認(rèn)為CA19-9水平在糖尿病患者及酮癥酸中毒患者中的良性升高是糖尿病患者胰腺外分泌腺存在損傷之反映的觀點(diǎn)有其合理性,高血糖狀態(tài)帶來的高糖毒性是其損傷機(jī)制之一,其他可能的損傷因素包括高胰高血糖素、胰島素抵抗、炎癥、自身免疫、酮癥酸中毒過程中的病理生理變化如缺氧、脫水、酸中毒、電解質(zhì)紊亂等。人們?cè)?jīng)在相當(dāng)長的時(shí)間里都認(rèn)為胰腺內(nèi)外分泌腺是互相獨(dú)立的兩部分,直到用電鏡觀察到了胰島、腺泡、導(dǎo)管的微結(jié)構(gòu)才開始關(guān)注內(nèi)外分泌腺之間的聯(lián)系,事實(shí)上胰腺內(nèi)外分泌腺無論在解剖上還是功能上都密切關(guān)聯(lián)。解剖上,胰島-腺泡軸、胰島-腺泡門靜脈系統(tǒng)的發(fā)現(xiàn)以及胰島-導(dǎo)管軸的發(fā)現(xiàn)都揭示了胰島與胰腺腺泡-導(dǎo)管系統(tǒng)存在直接的聯(lián)系[13];功能上,胰腺外分泌在一定程度上受胰腺內(nèi)分泌的調(diào)節(jié),如胰島素對(duì)胰腺外分泌具有營養(yǎng)和促進(jìn)分泌的作用,而胰高血糖素、生長抑素則有抑制作用[14]。糖尿病患者,無論是1型還是2型都存在胰腺內(nèi)分泌功能障礙,而越來越多研究表明糖尿病患者外分泌腺也存在病理生理改變[15-17],這一點(diǎn)也被許多研究及1型、2型、胰島素抵抗的糖尿病動(dòng)物模型所證實(shí),即胰腺外分泌腺在病理上的確存在改變,包括外分泌腺腺泡萎縮、導(dǎo)管擴(kuò)張、間質(zhì)纖維化等。CA19-9是與胰腺關(guān)系最為密切的腫瘤標(biāo)志物,它主要在胰腺外分泌腺和膽道上皮細(xì)胞中合成,它在腫瘤狀態(tài)下由腫瘤細(xì)胞合成,但它也可以在胰腺炎等非腫瘤性病變的情況下合成增多,在糖尿病造成的胰腺慢性損傷狀態(tài)下,它的合成也增加,其中具體的調(diào)控機(jī)制尚待探索。這可能是糖尿病患者CA19-9平均水平高于健康人群的原因。許多研究報(bào)道急性胰腺炎在酮癥酸中毒過程的發(fā)生率至少為10%~15%,雖然大部分情況下為輕度急性胰腺炎[18]。早前的尸檢研究也證實(shí)了酮癥酸中毒病例中胰腺均存在不同程度的壞死。酮癥酸中毒是糖尿病急性并發(fā)癥,其病理生理過程包括更嚴(yán)重的高血糖、胰島素絕對(duì)缺乏、胰高血糖素的不恰當(dāng)分泌增多、胰島素抵抗以及高滲、脫水、缺氧、酸中毒、電解質(zhì)紊亂等引起細(xì)胞功能障礙,以及夾雜于其中的感染、應(yīng)激因素,筆者認(rèn)為這個(gè)“酮癥酸中毒打擊”的過程加重糖尿病患者原已存在的胰腺內(nèi)外分泌系統(tǒng)慢性損傷,這可以解釋CA19-9在酮癥酸中毒患者中較非酮癥患者更易出現(xiàn)升高,且升高程度更高的現(xiàn)象。

        本研究還觀察到升高的CA19-9數(shù)值一般分布在200 U/mL之內(nèi),呈輕中度升高,其中10例患者在酮癥酸中毒病情糾正后復(fù)查CA19-9水平均呈下降趨勢(shì),CA19-9升高的程度與變化趨勢(shì)和其他研究報(bào)道一致[19],這可能提示胰腺外分泌系統(tǒng)在損傷過后存在某種修復(fù)機(jī)制,這與CA19-9腫瘤性合成增多存在根本差別。對(duì)于上述結(jié)論,必須指出本研究樣本量小,對(duì)于所得出結(jié)論的分析具有推測(cè)性,尚需要更多的研究來肯定或否定。

        綜上所述,筆者認(rèn)為臨床工作中對(duì)于血糖控制差或酮癥酸中毒狀態(tài)下CA19-9升高的患者應(yīng)采取謹(jǐn)慎又合理的態(tài)度。應(yīng)注重該指標(biāo)的復(fù)查,并根據(jù)復(fù)查情況決定是否需進(jìn)一步篩查腫瘤,從而避免不必要的醫(yī)療浪費(fèi)和侵入性檢查給患者造成的痛苦。同時(shí),臨床工作中應(yīng)更注重對(duì)患者血糖水平的控制、更及時(shí)發(fā)現(xiàn)并糾正酮癥酸中毒狀態(tài),以避免胰腺內(nèi)外分泌腺損傷的加重,從而保護(hù)胰腺功能。

        參考文獻(xiàn)

        [1]Li J, Cao G, Ma Q, et al. The bidirectional interation between pancreatic cancer and diabetes[J]. World J Surg Oncol,2012,24(10):171.endprint

        [2] Burney S, Irfan K, Saif M W, et al. Diabetes and pancreatic cancer[J]. JOP,2014,15(4):319-321.

        [3] Ventrucci M, Pozzato P, Cipolla A, et al. Persistent elevation of serum CA 19-9 with no evidence of malignant disease[J]. Dig Liver Dis,2009,41(5):357-363.

        [4] Akdogan M. Extraordinarily elevated CA19-9 in benign conditions: a case report and review of the literature[J]. Tumori,2001,87(5):337-339.

        [5] Sezer K. Normal CA 19-9 levels in Hashimoto's thyroiditis[J]. Asian Pac J Cancer Prev,2009,10(2):315-318.

        [6]魯礴,楊玉梅,張萍.2型糖尿病患者血清CA19-9、hs-CRP水平變化的研究[J].中外醫(yī)學(xué)研究,2011,8(28):27-28.

        [7] Yu H Y, Bao Y Q, Zhang L, et al. Relation between the level of serum CA19-9 and glucose control in inpatients with diabetes[J]. National Medical Journal of China,2010,90(6):394-396.

        [8] Esteghamati A, Hafezi-Nejad N, Zandieh A, et al. CA 19-9 is associated with poor glycemic control in diabetic patients: role of insulin resistance[J]. Clin Lab,2014,60(3):441-447.

        [9] Petit J M, Vaillant G, Olsson N O, et al. Elevated serum CA19-9 levels in poorly controlled diabetic patients[J]. Gastroenterol Clin Biol,1994,18(1):17-20.

        [10] Murai J, Soga S, Saito H, et al. Study on the mechanism causing elevation of serum CA19-9 levels in diabetic patients[J]. Endocr J,2013,60(7):885-891.

        [11]俞利紅,朱麒錢,官莉莉,等.2型糖尿病患者血清CA199水平的相關(guān)因素研究[J].中國全科醫(yī)學(xué),2011,2(10):32-34.

        [12] Benhamou P Y. Influence of metabolic disturbances of diabetes mellitus on serum CA 19-9 tumor marker[J]. Diabete Metab,1991,17(1):39-43.

        [13] Bertelli E, Regoli M, Orazioli D, et al. Association between islets of Langerhans and pancreatic ductal system in adult rat. Where endocrine and exocrine meet together?[J]. Diabetologia,2001,44(5):575-584.

        [14] Henderson J R, Daniel P M, Fraser P A. The pancreas as a single organ: the influence of the endocrine upon the exocrine part of the gland[J]. Gut,1981,22(2):158-167.

        [15] Lankisch P G, Manthey G, Otto J, et al. Exocrine pancreatic function in insulin-dependent diabetes mellitus[J]. Digestion,1982,25(3):211-216.

        [16] Hardt P D, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes?[J]. Exp Diabetes Res,2011,2011(761):950.

        [17] Yu H, Li R, Zhang L, et al. Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients[J]. Exp Diabetes Res,2012,2012(745):189.

        [18] Nair S, Yadav D, Pitchumoni C S. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA[J]. Am J Gastroenterol,2000,95(10):2795-800.

        [19] Pei-Chi Chen, Hong-Da Lin. Reversible high blood CEA and CA19-9 concentrations in a diabetic patient[J]. Libyan J Med,2012,7(10):3402.

        (收稿日期:2014-05-07) (本文編輯:王宇)endprint

        [2] Burney S, Irfan K, Saif M W, et al. Diabetes and pancreatic cancer[J]. JOP,2014,15(4):319-321.

        [3] Ventrucci M, Pozzato P, Cipolla A, et al. Persistent elevation of serum CA 19-9 with no evidence of malignant disease[J]. Dig Liver Dis,2009,41(5):357-363.

        [4] Akdogan M. Extraordinarily elevated CA19-9 in benign conditions: a case report and review of the literature[J]. Tumori,2001,87(5):337-339.

        [5] Sezer K. Normal CA 19-9 levels in Hashimoto's thyroiditis[J]. Asian Pac J Cancer Prev,2009,10(2):315-318.

        [6]魯礴,楊玉梅,張萍.2型糖尿病患者血清CA19-9、hs-CRP水平變化的研究[J].中外醫(yī)學(xué)研究,2011,8(28):27-28.

        [7] Yu H Y, Bao Y Q, Zhang L, et al. Relation between the level of serum CA19-9 and glucose control in inpatients with diabetes[J]. National Medical Journal of China,2010,90(6):394-396.

        [8] Esteghamati A, Hafezi-Nejad N, Zandieh A, et al. CA 19-9 is associated with poor glycemic control in diabetic patients: role of insulin resistance[J]. Clin Lab,2014,60(3):441-447.

        [9] Petit J M, Vaillant G, Olsson N O, et al. Elevated serum CA19-9 levels in poorly controlled diabetic patients[J]. Gastroenterol Clin Biol,1994,18(1):17-20.

        [10] Murai J, Soga S, Saito H, et al. Study on the mechanism causing elevation of serum CA19-9 levels in diabetic patients[J]. Endocr J,2013,60(7):885-891.

        [11]俞利紅,朱麒錢,官莉莉,等.2型糖尿病患者血清CA199水平的相關(guān)因素研究[J].中國全科醫(yī)學(xué),2011,2(10):32-34.

        [12] Benhamou P Y. Influence of metabolic disturbances of diabetes mellitus on serum CA 19-9 tumor marker[J]. Diabete Metab,1991,17(1):39-43.

        [13] Bertelli E, Regoli M, Orazioli D, et al. Association between islets of Langerhans and pancreatic ductal system in adult rat. Where endocrine and exocrine meet together?[J]. Diabetologia,2001,44(5):575-584.

        [14] Henderson J R, Daniel P M, Fraser P A. The pancreas as a single organ: the influence of the endocrine upon the exocrine part of the gland[J]. Gut,1981,22(2):158-167.

        [15] Lankisch P G, Manthey G, Otto J, et al. Exocrine pancreatic function in insulin-dependent diabetes mellitus[J]. Digestion,1982,25(3):211-216.

        [16] Hardt P D, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes?[J]. Exp Diabetes Res,2011,2011(761):950.

        [17] Yu H, Li R, Zhang L, et al. Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients[J]. Exp Diabetes Res,2012,2012(745):189.

        [18] Nair S, Yadav D, Pitchumoni C S. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA[J]. Am J Gastroenterol,2000,95(10):2795-800.

        [19] Pei-Chi Chen, Hong-Da Lin. Reversible high blood CEA and CA19-9 concentrations in a diabetic patient[J]. Libyan J Med,2012,7(10):3402.

        (收稿日期:2014-05-07) (本文編輯:王宇)endprint

        [2] Burney S, Irfan K, Saif M W, et al. Diabetes and pancreatic cancer[J]. JOP,2014,15(4):319-321.

        [3] Ventrucci M, Pozzato P, Cipolla A, et al. Persistent elevation of serum CA 19-9 with no evidence of malignant disease[J]. Dig Liver Dis,2009,41(5):357-363.

        [4] Akdogan M. Extraordinarily elevated CA19-9 in benign conditions: a case report and review of the literature[J]. Tumori,2001,87(5):337-339.

        [5] Sezer K. Normal CA 19-9 levels in Hashimoto's thyroiditis[J]. Asian Pac J Cancer Prev,2009,10(2):315-318.

        [6]魯礴,楊玉梅,張萍.2型糖尿病患者血清CA19-9、hs-CRP水平變化的研究[J].中外醫(yī)學(xué)研究,2011,8(28):27-28.

        [7] Yu H Y, Bao Y Q, Zhang L, et al. Relation between the level of serum CA19-9 and glucose control in inpatients with diabetes[J]. National Medical Journal of China,2010,90(6):394-396.

        [8] Esteghamati A, Hafezi-Nejad N, Zandieh A, et al. CA 19-9 is associated with poor glycemic control in diabetic patients: role of insulin resistance[J]. Clin Lab,2014,60(3):441-447.

        [9] Petit J M, Vaillant G, Olsson N O, et al. Elevated serum CA19-9 levels in poorly controlled diabetic patients[J]. Gastroenterol Clin Biol,1994,18(1):17-20.

        [10] Murai J, Soga S, Saito H, et al. Study on the mechanism causing elevation of serum CA19-9 levels in diabetic patients[J]. Endocr J,2013,60(7):885-891.

        [11]俞利紅,朱麒錢,官莉莉,等.2型糖尿病患者血清CA199水平的相關(guān)因素研究[J].中國全科醫(yī)學(xué),2011,2(10):32-34.

        [12] Benhamou P Y. Influence of metabolic disturbances of diabetes mellitus on serum CA 19-9 tumor marker[J]. Diabete Metab,1991,17(1):39-43.

        [13] Bertelli E, Regoli M, Orazioli D, et al. Association between islets of Langerhans and pancreatic ductal system in adult rat. Where endocrine and exocrine meet together?[J]. Diabetologia,2001,44(5):575-584.

        [14] Henderson J R, Daniel P M, Fraser P A. The pancreas as a single organ: the influence of the endocrine upon the exocrine part of the gland[J]. Gut,1981,22(2):158-167.

        [15] Lankisch P G, Manthey G, Otto J, et al. Exocrine pancreatic function in insulin-dependent diabetes mellitus[J]. Digestion,1982,25(3):211-216.

        [16] Hardt P D, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes?[J]. Exp Diabetes Res,2011,2011(761):950.

        [17] Yu H, Li R, Zhang L, et al. Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients[J]. Exp Diabetes Res,2012,2012(745):189.

        [18] Nair S, Yadav D, Pitchumoni C S. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA[J]. Am J Gastroenterol,2000,95(10):2795-800.

        [19] Pei-Chi Chen, Hong-Da Lin. Reversible high blood CEA and CA19-9 concentrations in a diabetic patient[J]. Libyan J Med,2012,7(10):3402.

        (收稿日期:2014-05-07) (本文編輯:王宇)endprint

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