【摘要】 目的 探讨脂肪酸代谢谱与T2DM酮症（DK）、DKA的相关性。方法 选取2019年1月至2021年8月于大连医科大学附属第二医院内分泌科住院治疗的T2DM患者308例，根据有无合并DK及DKA分为合并组和单纯T2DM组，每组各154例。根据疾病类型将合并组分为DKA亚组（n=40）和DK亚组（n=114）。比较各组生化指标及脂肪酸代谢谱指标。结果 与T2DM组比较，合并组DM病程、FC-P、肉豆蔻酸、硬脂酸、肉豆蔻油酸、棕榈油酸、亚麻酸、二十碳二烯酸、二十碳三烯酸、二十碳五烯酸、二十二碳五烯酸、二十二碳六烯酸、芥酸、ω-3/ω-6、三烯/四烯、总ω3降低（P<0.05或P<0.01）,FPG、HbA₁c升高（P<0.01）。与DKA亚组比较，DK亚组年龄、DM病程、FC-P、HDL-C升高（P<0.05或P<0.01）,HbA₁c、TG、SUA、肉豆蔻油酸、棕榈油酸、棕榈酸、油酸、花生四烯酸、二十碳烯酸、二十碳三烯酸、二十二碳四烯酸、三烯/四烯、总单不饱和脂肪酸、总脂肪酸降低（P<0.05或P<0.01）。Spearman相关分析显示，神经酸、花生四烯酸与HbA₁c呈正相关（P<0.05），棕榈油酸、二十碳五烯酸与HbA₁c呈负相关（P<0.01）。棕榈油酸、油酸、花生四烯酸与HOMA-IR呈正相关（P<0.05）。Logistic回归分析结果显示，肉豆蔻酸、硬脂酸、棕榈油酸、亚麻酸、二十碳三烯酸、二十碳五烯酸、二十二碳六烯酸、三烯/四烯、总ω3是DK或DKA的影响因素。结论 DK、DKA脂肪酸代谢紊乱可能与胰岛功能降低相关，T2DM患者血糖控制水平、脂肪酸变化与DK、DKA发生发展密切相关。更多还原

【Abstract】 Objective To investigate the correlation between the fatty acid metabolism profile of s type2 diabetes mellitus（T2DM）ketosis（DK）and ketoacidosis（DKA）.Methods A total of 308 patients with T2DM who were hospitalized in The Second Affiliated Hospital of Dalian Medical University from January2019 to August 2021 were selected. According to whether there was ketosis and ketoacidosis,they were divided into a combined group and a simple T2DM group,with 154 cases in each group. The intoxication group was further divided into DKA subgroup（n=40）and DK subgroup（n=114）. The biochemical indexes and fatty acid profile indexes of each group were compared.Results Compared with T2DM group,the DM duration,FC-P,myristic acid,stearic acid,myristic acid,palmitoleic acid,linolenic acid,eicosapentaenoic acid,eicosapentaenoic acid,eicosahexaenoic acid,eicosapentaenoic acid,erucic acid,ω-3/ω-6,triene/tetraene,and total ω3 in the combined group decreased（P<0. 05 or P<0. 01）,and FPG and HbA₁c increased（P<0. 01）. Compared with DKA subgroup,the age,DM duration,FC-P,HDL-C of DKA subgroup were higher（P<0. 05 or P<0. 01）,and HbA₁c,TG,SUA,myristic oleic acid,palmitoleic acid,palmitic acid,oleic acid,arachidonic acid,eicosapentaenoic acid,eicosapentaenoic acid,docosatetraenoic acid,triene/tetraene,total monounsaturated fatty acids and total fatty acids decreased（P<0. 05 or P<0. 01）.Spearman correlation analysis showed that nervonic acid and arachidonic acid was positively correlated with HbA₁c（P<0. 05）,palmitoleic acid and eicosapentaenoic acid were negatively correlated with HbA₁c（P<0. 01）,palmitoleic acid,oleic acid and arachidonic acid were positively correlated with HOMA-IR（P<0. 05）. Logistic regression analysis showed that the levels of myristic acid,stearic acid,palmitoleic acid,linolenic acid,eicosapentaenoic acid,docosahexaenoic acid and eicosatriene,triene/tetraene and total ω3were the influencing factors of DK or DKA.Conclusion The disorder of fatty acid levels in DK and DKA may be related to the decline of islet function. The blood glucose control level and the changes of fatty acids in T2DM patients are closely related to the occurrence and development of DK and DKA.更多还原