摘要
目的 比较分析暴发性1型糖尿病及经典1型糖尿病的临床特征,探讨暴发性1型糖尿病的发病机制.方法 入选2005年9月至2009年9月在我院内分泌科住院的以酮症酸中毒为首发症状的暴发性1型糖尿病患者6例(暴发性1型糖尿病组)和以酮症酸中毒为首发症状的初发经典1型糖尿病患者24例(经典1型糖尿病组),回顾性分析两组患者的临床特征,包括发病年龄、糖尿病病程、咽痛、咳嗽、发热等流感样症状、恶心、呕吐、腹痛等消化道症状、入院时随机血糖、糖化血红蛋白、C肽、丙氨酸转氨酶、肌酸激酶、肌酐、血钾、白细胞计数等.计量资料和计数资料分别采用t检验或x2检验进行统计分析.结果 与经典1型糖尿病组相比,暴发性1型糖尿病组发病年龄升高[分别为(46±6)、(19±6)岁,t=9.89,P＜0.01],糖尿病病程明显缩短[分别为(3.5±2.7)、(52.5±32.6)d,t=3.63,P＜0.01],咽痛、咳嗽、发热等流感样症状明显增多[分别为50%(3/6)、0(0/24),x2=13.33,P＜0.01],恶心、呕吐、腹痛等消化道症状亦增多[分别为83%(5/6)、0(0/24),x2=24.00,P＜0.01].与经典1型糖尿病组相比,暴发性1型糖尿病组入院时随机血糖升高[分别为(44±7)、(23±4)mmol/L,t=9.22,P＜0.01],糖化血红蛋白降低[分别为(7.1±1.0)%、(14.4±2.2)%,t=7.66,P＜0.01],餐后2 h C肽减少[分别为(0.21±0.17)、(0.58±0.39)μg/L,t=2.29,P＜0.05],丙氨酸转氨酶增高[分别为(206±124)、(10±2)U/L,t=8.18,P＜0.01],肌酸激酶升高[分别为(1038±447)、(79±10)U/L,t=11.11,P＜0.01],肌酐增加[分别为(179±39)、(55±16)μmol/L,t=12.33,P＜0.01],血钾升高[分别为(5.2±0.7)、(3.4±0.8)mmol/L,t=5.07,P＜0.01],白细胞计数增多[分别为(21.0±8.1)×109个/L、(6.0±1.9)×109个/L,t=8.64,P＜0.01].结论 暴发性1型糖尿病患者存在胰岛β细胞功能衰竭,代谢紊乱更为严重,免疫反应更加强烈,容易导致多脏器功能损害.
Objective To compare the clinical features of fulminant type 1 diabetes mellitus with classic type 1 diabetes mellitus and to explore the mechanism of fulminant type 1 diabetes mellitus. Methods Of the patients admitted in our hospital from September 2005 to September 2009, six were diagnosed with fulminant type 1 diabetes ( F group) and 24 were diagnosed with classic type 1 diabetes ( NF group). Their medical data, including flu-like symptoms, nausea, vomiting or abdominal pain, blood glucose, HbA1c, C peptide, alanine aminotransferase, creatine kinase, creatinine, blood potassium, and blood white cell count were retrospectively analyzed. x2 or t test was used for data analysis. Results In comparison with the NF group, the age of onset of F group was higher ( (46 ± 6) vs ( 19 ± 6) years, t = 9.89, P ＜ 0.01 ), the course of disease was shorter ( (3.5 ± 2.7) vs (52.5 ± 32.6) d, t = 3.63, P ＜ 0.01 ), flu-like symptoms were more commonly seen (50% (3/6) vs 0 (0/24), x2 = 13.33, P ＜ 0.01 ), nausea, vomiting or abdominal pain were also increased (83%(5/6) vs 0(0/24),x2 =24.00, P ＜0.01 ). The blood glucose of the F group was higher than that of the NF group ( (44 ±7) vs (23 ±4) mmol/L,t =9.22,P ＜0.01 ), HbAlc was decreased ((7.1 ± 1.0)% vs (14.4 ±2.2)%,t =7.66, P＜0.01), 2-h C peptide was lower ( (0.21 ±0.17) vs ( 0.58 ± 0.39 ) μg/L, t = 2.29, P ＜ 0.05 ), alanine aminotransferase was higher ((206±124) vs (10±2) U/L,t=8. 18, P＜0.01), the creatine kinase was increased ((1038 ±447)vs (79 ± 10) U/L,t = 11.11, P ＜0.01 ), creatinine was also increase ( ( 179 ±39)vs (55 ± 16) μmol/L,t =12.33,P＜0.01), blood kalium was higher ((5.2 ±0.7) vs (3.4 ±0.8) mmol/L,t =5.07,P＜0.01),the blood white cell count was more ((21.0 ±8.1) × 109/L vs (6.0±1.9) ×109/L,t=8.64,P＜0.01).Conclusion Islet beta-cell function failure, serious metabolic disorder, more intense immune response and multiple organ dysfunctions may be found in patients with fulminant type 1 diabetes mellitus.
出处
《中华糖尿病杂志》
CAS
2010年第5期-,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
