儿童糖尿病198例

Diabetes Mellitus in 198 Children

目的探讨儿童糖尿病(DM)的临床特点,为临床诊治提供理论依据。方法对1999年1月-2009年3月在本院住院的198例DM患儿的临床表现和实验室检查进行回顾性临床分析。结果 198例DM患儿中,男97例,女101例。均为首诊病例;发病高峰年龄为5～6岁及9～11岁;首诊例数逐年增加,2008年较1999年增加了3.7倍;其中1型糖尿病(T1DM)174例(占88.9%),2型糖尿病7例(占3.5%),新生儿DM 14例(占7.1%),其他3例(占1.5%)。首诊的T1DM患者中,酮症酸中毒(DKA)的发生率为42.0%;发病前有感染史者55例,与无感染史者比较,DKA的发生率有统计学差异(P<0.01)。有DM家族遗传史者23例。并甲状腺功能亢进症2例;并暂时性甲状腺功能减低症31例;并肝功能异常30例,肾功能异常12例,血脂异常48例,尿蛋白阳性27例。糖化血红蛋白为(12.0±1.8)%;共分析了25例T1DM患者的自身抗体,胰岛细胞抗体阳性率为28%,胰岛素自身抗体的阳性率为20%,谷氨酸脱羧酶自身抗体(GADA)阳性率为72%。结论首诊的儿童DM逐年增加,以T1DM为主;新生儿DM增加明显;DKA是T1DM患者就诊的重要原因;首诊的T1DM者中,感染是发生DKA的重要诱因;儿童DM常合并暂时性甲状腺功能减低症、肝肾功能异常及血脂异常;糖尿病自身抗体中GADA的阳性率最高。

Objective To investigate the clinical characteristics and provide theoretic basis of diabetes mellitus（DM） for the diagnosis and treatment. Methods The clinical manifestation and laboratory examination of 198 children with DM from Jan.1999 to Mar.2009 in Guangzhou Women and Children′s Medical Center were analyzed retrespectively. Results Among total 198 new cases of children with DM,there were 97 boys and 101 girls;the onset peak age was 5 to 6 years old and 9 to 11 years old;new cases were increasing year by year and cases of 2008 were 3.7 times than those of 1999;Among 198 new cases,174（88.9%） cases with type 1 diabetes mellitus（T1DM）,7（3.5%） cases with type 2 diabetes mellitus,14（7.1%） cases with neonatal DM and 3（1.5%） case with other types.Among the new cases with T1DM,the incidence of diabetic ketoacidosis（DKA） was 42.1%;55 cases had infection history before the onset of disease;the incidence of DKA had significant difference between the infection group and the non-infection group（P0.01）;23 cases had family history.Two cases with hyperthyroidism,31 cases with temporary hypothyroidism,30 cases with liver function damage,12 cases with kidney function da-mage,48 cases with dislipidemia,27 cases with proteinuria;the average HbA1c was（12.0±1.8）%,the positive rate of islet cells antibodies in 25 cases of T1DM was 28%,the positive rate of insulin auto-antibody was 20% and the positive rate of glutamic acid decarboxylase antibody（GADA） was 72%. Conclusions New cases with DM are increasing year by year and most cases are T1DM;cases with neonatal diabetes increase significantly;DKA is the important reason of children with T1DM going to hospital and infections is the important incentive of DKA;children with DM has also temporary hypothyroidism,liver function damage,kidney function damage and dislipidemia;the positive rate of GADA is the highest in autoimmune antibodies.