胰腺纤维钙化性糖尿病长期误诊为1型糖尿病1例报告并文献复习

Fibrocalculous pancreatic diabetes misdiagnosed as type 1 diabetes for years:A case report and literature review

目的通过分析1例胰腺纤维钙化性糖尿病(fibrocalculous pancreatic diabetes,FCPD)长期误诊为1型糖尿病的病例,探讨上述两种类型糖尿病的鉴别诊断及相关临床特征,为其诊治提供参考。方法分析我院收治的1例30岁男性FCPD患者的诊治经过及临床特点。结果患者既往诊断1型糖尿病13年,本次因腹痛、呕吐就诊。入院查血酮体阳性,谷氨酸脱羧酶抗体阳性,血淀粉酶、脂肪酶明显升高,腹部CT提示慢性胰腺炎急性发作,胰腺超声提示胰腺回声不均匀,内可见密布钙化沉积。结合患者病史、症状,特别是影像学结果分析,尽管该患者胰岛功能差,胰岛抗体阳性,但其胰腺影像学检查提示典型胰腺钙化病变,明确该患者为FCPD,而非1型糖尿病。结论FCPD与1型糖尿病鉴别的焦点并非合并酮症及自身抗体阳性与否,而在于胰腺影像学改变情况。

Objective To report a case with fibrocalculous pancreatic diabetes(FCPD)who was misdiagnosed as type 1 diabetes(T1DM),and provide evidence for the differential diagnosis.Methods The diagnosis,treatment and clinical characteristics of a 30-year-old male FCPD patient admitted to our department in 2019 were analyzed.Results The patient had been diagnosed as type 1 diabetes for 13 years.He was admitted to our hospital for abdominal pain and vomiting.Laboratory testing results indicated that blood ketone body was positive,glutamic acid decarboxylase antibody was positive,and his blood amylase and lipase increased significantly.Abdominal CT indicated acute attack of chronic pancreatitis,while pancreatic ultrasound showed uneven pancreatic echo with dense calcification.By reviewing the history,although the patient had poor islet function and positive islet antibody,the pancreatic imaging examination showed typical pancreatic calcification,which confirmed that the patient was FCPD rather than type 1 diabetes.Conclusion The key of differentiating FCPD and type 1 diabetes is not whether there are combining ketone disease and auto-antibodies positive or not,but is pancreatic imaging changes.