暴发性1型糖尿病的特点与诊治

The feature, diagnosis, and treatment of fulminant type 1 diabetes

1型糖尿病包括自身免疫性（1A）和特发性（1B）两种类型。近年发现了一种发展更为迅速、病情更为严重的暴发性1型糖尿病。这类患者占酮症或酮症酸中毒起病的1型糖尿病的15％～20％。该病与HLAⅡ类抗原和病毒感染有一定联系。由于起病急骤，虽然患者的血糖很高，但HbA1c水平几乎正常。因此凡遇到超高血糖而HbA1c接近正常的酮症酸中毒患者，应考虑暴发性1型糖尿病的诊断。对该病的治疗和1型糖尿病没有区别，但因其发展迅速，抢救更应及时。

Type 1 diabetes includes two categories ： autoimmune （ type 1A ） and idiopathic （ type 1B ） diabetes. Fulminant type 1 diabetes is a recently discovered subtype of type 1 diabetes with extremely rapid progression of hyperglycemia and ketoacidosis. The prevalence of fulminant type 1 diabetes among acute-onset type 1 diabetic patients is around 15%-20%. Class Ⅱ HLA genotype and virus infection may contribute to its development. The near-normal HbAlc level despite a very high plasma glucose concentration in patients with ketoacidosis is the clue to diagnosis of fulminant type 1 diabetes. Treatment must be started immediately and aggressively when the diagnosis of fulminant type 1 diabetes is made or strongly suspected.