GA/HbA1c、LCR、BAR在不同严重程度1型糖尿病酮症酸中毒患儿血清中的表达及意义OA

Objective To investigate the expression and clinical significance of serum glycated albumin/glycated he-moglobin ratio(GA/HbA1c),lymphocyte-to-C-reactive protein ratio(LCR),and bilirubin-to-albumin ratio(BAR)in children with type 1 diabetes mellitus complicated by diabetic ketoacidosis(T1DM combined with DKA)of different severities.Meth-ods A total of 84 children with T1DM combined with DKA admitted to the Department of Pediatrics,Jianyang People's Hospital of Sichuan Province from October 2022 to October 2025 were enrolled as the DKA group,84 children with simple T1DM as the T1DM group,and 84 healthy children undergoing physical examination during the same period as the healthy control group.Children with T1DM combined with DKA were further divided into a mild subgroup(n=29),a moderate sub-group(n=32),and a severe subgroup(n=23).Pearson correlation analysis was used to evaluate the correlation between serum GA/HbA1c,LCR,BAR levels and the severity of T1DM-DKA.ROC curve analysis was performed to assess the diagnostic value of each index for severe T1DM-DKA,and decision curve analysis(DCA)was used to evaluate the clinical net benefit of diagnosing severe T1DM-DKA.Results Serum GA/HbA1c and BAR levels:DKA group＞T1DM group＞healthy control group.Serum LCR levels:DKA group＜T1DM group＜healthy control group(F/P=262.599/＜0.001,217.262/＜0.001,329.842/＜0.001).Serum GA/HbA1c and BAR levels:severe subgroup＞moderate subgroup＞mild subgroup.Serum LCR lev-els:severe subgroup＜moderate subgroup＜mild subgroup(F/P=262.599/＜0.001,329.842/＜0.001,217.262/＜0.001).Correla-tion analysis showed that serum GA/HbA1c(r=0.625)and BAR(r=0.521)levels were positively correlated with the severity of DKA,while LCR level(r=-0.595)was negatively correlated with the severity of DKA(all P＜0.001).The AUCs of serum GA/HbA1c,LCR,BAR,and their combination for diagnosing severe T1DM-DKA in children were 0.790,0.783,0.747,and 0.882,respectively.The combined AUC was superior to each individual marker(Z/P=2.102/＜0.001,2.122/＜0.001,2.991/＜0.001).DCA curve analysis indicated that when the risk threshold for disease severity in children with T1DM-DKA was 0.08-0.88,the clinical net benefit of combined detection of serum GA/HbA1c,LCR,and BAR was greater than that of each marker alone.Conclusion Serum GA/HbA1c and BAR levels increase with the aggravation of T1DM-DKA in children,while LCR level decreases.Combined detection of the three indicators has high diagnostic value for severe T1DM-DKA.