儿童1型糖尿病103例临床特点及疗效分析

Clinical features and treatment of type 1 diabetes mellitus in children

目的回顾分析儿童1型糖尿病（T1DM）的发病状况，探讨其临床特点及诊治方法。方法对2002年2月至2010年8月成都市妇女儿童中心医院住院的T1DM患儿103例的临床资料进行回顾性分析，并将其中不同的胰岛素给药方法的31例学龄期糖尿病酮症酸中毒患儿分为基础一餐时胰岛素治疗组和胰岛素泵治疗组，进行疗效分析，比较其血糖达标所需时间、低血糖发生情况、血糖波动情况、治疗达标时空腹血糖、餐后2h血糖水平、每日胰岛素用量、尿酮体消失时间、住院时间等。结果103例T1DM患儿年龄38d至15岁4个月，平均（8±3）岁；初发病例78例（75．7％），男孩多见（57例，55．3％），发病年龄以7～10岁最多（47例，占45．6％），冬春季发病51例（49．5％），合并感染67例（65．2％），以呼吸道感染（27例）和消化道感染（15例）多见。而62例（60．2％）以酮症酸中毒就诊，并发脑水肿者4例（3．9％）。部分患儿合并桥甲炎、甲状腺功能亢进、系统性红斑狼疮等自身免疫性疾病。不同的胰岛素给药方法患儿治疗后空腹血糖及餐后血糖均明显下降，差异无统计学意义（P〉0．05）。胰岛素泵治疗组酸中毒纠正时间短、尿酮体消失快（P〈0．01），血糖达标时间短（P〈0．01），血糖波动幅度小、持续时间短，胰岛素用量少，住院时间短，与基础一餐时胰岛素治疗组比较差异有统计学意义（P〈0．05）。结论儿童T1DM起病临床表现不典型，易合并酮症酸中毒，感染可能是患儿出现糖尿病酮症酸中毒的重要诱因之一。胰岛素泵治疗可较好控制血糖，使用方便，是目前儿童T1DM较佳治疗方法。

Objective To review the clinical characteristics and treatment of type 1 diabetes mellitus （T1DM） in children. Methods The clinical data of 103 children with T1DM admitted to our hospital from Februry 2002 to August 2010 were retrospectively analyzed. Thirty one cases with diabetic ketoacidosis （KDA） were treated with continuous insulin pump （group A） or basal-bolus insulin therapy （group B ）. The differences in blood glucose control time, the rate of hypoglycemic episodes, glucose fluctuation, fasting blood glucose （FBG）, 2 h postprandial blood glucose （2 hPBG）, insulin dosage, the time of urine acetone bodies disappear and length of stay were compared in two groups. Results The age of 103 children with T1DM was from 38 d to 15.33 y with an average of （8 -＋3） y; most of them was 7 - 10 y （47, 45.6% ）. Seventy eight children were first diagnosed accounting for 75. 7%; boys accounted for 55.3% of total. Fifty one cases （49. 5% ） were diagnosed in winter and spring and 67 （65.2%） had infections, most of them were respiratory tract and gastrointestinal infections. Sixty two cases （ 60. 2% ） presented as diabetic ketoacidosis at the first onset, including 4 cases （3.9%） with cerebral edema. Some patients were complicated by Hashimoto＇s thyroiditis, hyperthyroidism, SLE and other autoimmune diseases. Among 31 cases with ketoacidosis the FBG and PBG were decreased significantly after treatment, there were no significant differences between two groups （ P 〉 0. 05 ）. Compared to group B the correction time of DKA and urine acetone bodies was shorter, and reached the targeted glucose levels more quickly, the frequency of blood fluctuation and the hypoglycemia was significantly lower, the length of stay was shorter, and the daily dose of insulin was lower in group A ; the differences between two groups were statistically significant （ P 〈 0. 05 or P 〈 0. 01 ）. Conclusions The clinical symptoms at first onset of T1DM in children are not typical,and likely to be combined with DKA; infection may be one of the inducing factors for DKA. Continuous subcutaneous insulin infusion with pump can control the blood glucose more effectively and equably, and are convenient for use by children; so it is a better treatment option for type 1 diabetes mellitus in children.