儿童初发糖尿病的诊断及分型指标研究

Diagnosis and classification indexes in newly diagnosed children diabetes mellitus

目的探讨儿童初发1型糖尿病(T1DM)与2型糖尿病(T2DM)的鉴别诊断指标。方法选择110例T1DM患儿(T1DM组)和20例T2DM患儿(T2DM组),采用SPSS10.0统计软件包分别比较其糖尿病家族史、发病年龄、发病至就诊时间、酮症酸中毒(DKA)、黑棘皮症发病率、体质量指数(BMI),腰围/身高比(W/H)、糖化血红蛋白(HbA1C)、空腹血糖(FBG)、餐后2 h血糖(2 hPG),空腹C肽(FCP)、空腹胰岛素(FINS)、胰岛素抵抗指数(IRI)、胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GAD)及有无胰岛素依赖。并设30例年龄、性别相匹配的健康儿童为对照组。结果①T1DM组发病年龄较小、发病急、DKA发病率高,多无糖尿病家族史,BMI及W/H低,无黑棘皮症,糖尿病自身免疫性抗体多阳性,FINS及FCP显著降低,无胰岛素抵抗,需胰岛素治疗才能使血糖达标及维持生命。②T2DM多有明显家族史、发病年龄多在10岁以后、发病缓慢,多伴有黑棘皮症,超重或肥胖,自身免疫性抗体多阴性,FINS及FCP较正常升高,显示胰岛素抵抗,DKA纠正后一般不需胰岛素治疗,通过减肥、运动、口服二甲双胍等可使血糖达标。结论①黑棘皮症、肥胖、胰岛素抵抗及无胰岛素依赖为诊断儿童初发T2DM的特异性指标。②FINS及FCP水平降低、无胰岛素抵抗、需依赖外源性胰岛素才能控制血糖和维持生命是诊断儿童T1DM的特异性指标。③发病年龄、家族史、DKA及自身免疫性抗体是重要的参考指标。

Objective To study the diagnosis and classification indexes of newly diagnosed type 1 diabetes mellitus （T1DM） and type 2 diabetes mellitus （T2DM） in children. Methods Diabetes family history, the age of onset, the time of appearing symptom to established diagnosis, DKA incidence, acanthosis nigricans, waist circumstance/high ratio （ WC/ H）, body mass index（BMI） ,HbAlc, FBG,FCP and FINS, IRI, islets cell autoimmune antibodies（ICA） ,glutamic acid decarboxylase （GAD） antibodies （GADA） and insulin dependence were compared between 110 newly diagnosed T1DM and 20 newly diagnosed T2DM in children. And related indexes were compared with that in healthy children. Results The TIDM characterized urgent incidence, small age of onset, high DKA incidence,less DM history,low BMI and WC/H, no acanthosis nigricans,high positive rate of ICA and（or） GADA,low FCP and FINS, no insulin resisitance and insulin dependence. The T2DM characterized high DM history, the age of onset 〉 10 a, slight symptom of polyuria,polydipsia, poiyphagia and weight loss, obvious acanthosis nigricans, obesity, lower positive rate of diabetes immunoantibodes, insulin resistance and no insulin dependence. Conclusions Acanthosis nigricans,obesity, insulin independence are characteristic indexes of newly onset T2DM. Decreased FCP and FINS, no insulin resistance and insulin dependence are characteristic indexes of newly diagnosed T1DM. Family history, the age of onset, DKA and GADA are important reference indexes.