摘要
目的分析16例暴发性1型糖尿病(FT1DM)患者的临床资料,提高临床医师对FT1DM的认识。方法选取2008年1月—2015年5月海南省人民医院收治住院的FT1DM患者16例。记录患者发病时临床症状;抽取肘静脉血,检测血糖、糖化血红蛋白(HbA1c)、D-3羟丁酸、总二氧化碳(CO_2)、血肌酐(Scr)、肌酸激酶(CK)、血淀粉酶、血常规、胰岛相关自身抗体〔谷氨酸脱羧酶抗体(GADAb)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)〕水平。患者在酮症或酮症酸中毒纠正后1~3 d,检测空腹C肽(FCP)和餐后2 h C肽(PCP)水平。对患者进行长期随访。结果 2008年1月—2015年5月,16例FT1DM患者占同期所有住院糖尿病患者(22 999例)的0.70‰,占住院1型糖尿病患者(457例)的3.5%。16例患者起病急骤,病程为12 h^6 d。临床症状上,15例患者出现恶心、呕吐,8例出现腹痛,6例伴上呼吸道感染,6例出现意识障碍,5例出现多饮、多尿,5例伴发热;血糖水平均明显升高(17.0~46.1 mmol/L);Hb A1c接近正常(5.6%~8.2%);FCP水平降低(<0.003~0.090 nmol/L);PCP水平降低(<0.003~0.160 nmol/L);动脉血pH值降低(6.92~7.30);血清D-3羟丁酸水平升高(5.18~9.69mmol/L);总CO2降低(1.0~20.0 mmol/L);12例Scr水平升高(94~275μmol/L);7例CK水平升高(263~5 373U/L);9例血淀粉酶水平升高(110~436 U/L);14例白细胞计数(WBC)升高〔(13.3~31.9)×10~9/L〕;胰岛β细胞功能几乎衰竭,迅速发展为糖尿病酮症酸中毒。入院后患者经积极补液扩容、小剂量胰岛素静脉滴注、纠正电解质紊乱抢救后,病情均好转。在酮症酸中毒纠正后继续胰岛素泵或基础+餐时胰岛素强化治疗,出院后沿用住院期间胰岛素强化治疗方案至今。8例患者门诊随访3~34个月,复查FCP、PCP仍接近于入院时水平。结论 FT1DM患者占同期所有住院糖尿病患者的0.70‰,占住院1型糖尿病患者的3.5%。FT1DM起病急骤、代谢紊乱严重,常合并多系统损害,部分患者以消化道或上
Objective To analyse the clinical features of 16 cases of fulminant type 1 diabetes（ FT1DM）,to increase awareness of FT1DM among clinicians. Methods 16 patients with FT1DM who were admitted to Hainan General Hospital from January 2008 to May 2015,were selected as study subjects. Chinical symptoms of the onset were recorded. Elbow venous blood was collected for whole blood cell analysis,and levels of blood glucose,glycosylated hemoglobin（ HbA1c）,D- 3hydroxybutyric acid,total carbon dioxide（ CO2）,serum creatinine（ Scr）,creatine kinase（ CK）,serum amylase,blood routine,insulin related auto antibodies 〔glutamic acid decarboxylase antibody（ GADAb）, islet cell antibodies（ ICA） and insulin autoantibodies（ IAA） 〕 were detected. 1- 3 days after correction of patients＇ ketosis or ketoacidosis,levels of fasting C peptide（ FCP） and 2 h postprandial C peptide（ PCP） were detected. Patients were followed up for a long time. Results There were 22 999 hospitalized patients with diabetes during January 2008 to May 2015,among whom FT1DM patients（ 16 cases）accounted for 0. 70‰,and FT1DM patients accounted for 3. 5% of hospitalized patients with type 1 diabetes（ 457 cases）. 16 patients presented with acute onset,and the duration of the disease was 12 hours to 6 days. In aspect of the clinical symptoms,15 cases had nausea and vomiting,8 cases had abdominal pain,6 cases had upper respiratory tract infection,6 cases had disturbance of consciousness,5 cases had polydipsia and polyuria,5 cases had fever. Blood glucose level increased significantly（ 17. 0- 46. 1 mmol/L）; HbA1 cwas close to normal level（ 5. 6%- 8. 2%）; FCP level decreased（ 〈0. 003- 0. 090 nmol / L）; PCP level decreased（ 〈0. 003- 0. 160 nmol / L）; arterial blood p H decreased（ 6. 92- 7. 30）; serum D- 3hydroxybutyric acid increased（ 5. 18- 9. 69 mmol / L）; total CO2decreased（ 1. 0- 20. 0 mmol / L）; 12 patients had elevated Scr level（ 94- 275 μmol / L）; 7 patients had elevated CK level�
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第21期2567-2571,共5页
Chinese General Practice
关键词
糖尿病
1型
血糖
血红蛋白A
糖基化
C肽
糖尿病酮症酸中毒
Diabetes mellitus
type 1
Blood glucose
Hemoglobin A
glycosylated
C-peptide
Diabetic ketoacidosis
