初发的自发酮症倾向糖尿病患者的临床特征及分型

Clinical characteristics and classification of ketosis-prone diabetes

目的探讨自发酮症起病的糖尿病患者的临床特征及分型。方法将206例自发酮症起病的糖尿病患者根据糖尿病抗体分为抗体阳性组、抗体阴性组。阴性组依据体质量分为肥胖组、非肥胖组。比较不同组别在起病年龄、体质量指数、体质量下降、C肽水平等方面的差异,并对抗体阳性组20例,阴性组50例进行了随访观察。结果抗体阳性与阴性组相比,起病年龄、体质量指数、C肽水平、血甘油三酯等差异有统计学意义,2组起病时血糖、体质量下降、糖尿病家族史等差异无统计学意义。肥胖组与非肥胖组相比,空腹血糖、C肽水平、血甘油三酯等差异有统计学意义,2组之间葡萄糖耐量试验(OGTT)2 h血糖、起病年龄、糖尿病家族史等差异无统计学意义。随访的抗体阳性20例患者,其中4例停用胰岛素治疗,16例继续胰岛素治疗,20例患者3个月后复查C肽,治疗前后差异无统计学意义。随访的50例抗体阴性患者中肥胖组21例停用胰岛素治疗,4例胰岛素治疗;非肥胖组16例停用胰岛素治疗,9例胰岛素治疗;50例患者中8例停用胰岛素患者3个月后复查C肽,2 hC肽水平治疗前后差异有统计学意义,2例继续胰岛素治疗患者C肽水平差异无统计学意义。结论在自发酮症倾向的初发患者中不仅包括1型糖尿病,也包括部分血糖升高的有胰岛素抵抗的2型糖尿病,对初发自发酮症倾向的糖尿病患者分型不明确者,需在病程中监测胰岛功能,逐渐明确分型。

Objective To investigate the clinical characteristics and classification of ketosis-prone diabetes.Methods Firstly,according to with or without auto-antibodies,patients with an initial onset of unprovoked ketosis or ketoacidosis were classified to two different groups.Secondly,in auto-antibodies negative group,according to body mass index（BMI）,patients were divided into obese group and non-obese group.Clinical characteristics,including age,body mass index,weight loss and C-peptide,were compared among different groups.Twenty auto-antibodies positive patients and 50 auto-antibodies negative patients were followed up.Results Compared with auto-antibodies negative group,the index such as onset age,the body mass index,C-peptide and blood triglyceride were lower in auto-antibodies positive group,there was no significant difference regarding some clinical features（glycemia glycated hemoglobin,weight loss,diabetes family history）.Compared with the non-obese group,fasting blood glucose,glycated hemoglobin,high-density and lipoprotein cholesterol level were lower in,the obese group,C-peptide levels and blood triglyceride were higher.There were no significant differences in OGTT 2 h blood glucose,onset age and family history of diabetes.During the follow-up,among 20 auto-antibodies positive patients,4 patients could stop insulin therapy,16 continued to use insulin therapy.After 3 months,20 auto-antibodies positive patients had review of islet function,there were no significant differences regarding C-peptide before and after treatment.Among 50 auto-antibodies negative patients,21 obese patients could stop insulin therapy,4 obese patients continued to use insulin therapy,16 non-obese patients could stop insulin and 9 non-obese patients continued to use insulin therapy（including 4 underweight patients and 5 normal weight patients）.After 3 months,8 out of 50 in auto-antibodies negative patients had review of islet function,there was higher postprandial C-peptide among 8 stopped insulin therapy patients,there was no significant differences regarding fasting C-peptide.In 2 insulin-using therapy patients,fasting C-peptide levels was less than 400 pmol/L,OGTT 2 h C-peptide was less than 800 pmol/L.Conclusion Ketosis-prone diabetes not only include type 1 diabetes but also include part of type 2 diabetes with hyperglycemia and insulin resistance.For new-onset and ketosis-prone diabetes,islet function must be monitored in the course to get a clear classification.