自发酮症起病的糖尿病患者临床特征及分型探讨

Ketoacidosis onset type of diabetes causes of clinical research

目的探讨以酮症或酮症酸中毒起病的糖尿病患者临床特征及其与分型的关系。方法收集我院收治的酮症或酮症酸中毒起病糖尿病患者105例，测定其血脂、血糖、糖化血红蛋白、胰岛功能和胰岛自身免疫抗体。根据胰岛自身免疫抗体阳性与否和胰岛功能将患者分为3组：抗体阳性和胰岛功能保留或不保留者为A组46例，抗体阴性和胰岛功能不保留者为B组10例，抗体阴性和胰岛功能保留者为c组49例；根据腰围、BMI分为2组：肥胖组60例，非肥胖组45例。入院后予胰岛素强化控制血糖，半年后复查血糖、糖化血红蛋白、胰岛功能，同时观察患者对胰岛素的依赖性。结果c组患者的年龄、BMI、随机血糖、糖化血红蛋白与A组和B组比较差异有统计学意义（P〈0．01），而TG、HDL-C仅与A组间比较差异有统计学意义（P〈0．01），胰岛储备及分泌功能均优于A组和B组（P〈0．01），6个月后93．87％的患者无需胰岛素治疗。肥胖组患者血清TC、TG水平较高，胰岛自身抗体阳性率低，发生酮症或酮症酸中毒时胰岛素缺乏程度较轻，胰岛β细胞储备功能尚好等特点。结论自发酮症起病的糖尿病患者临床特点存在差异，结合自身免疫抗体和胰岛β细胞功能可提示其临床表型亚型的归类，胰岛功能的动态观察有助于分型诊断。

Objective To study the relationship between clinical features and classification of di- abetes in ketosis or ketoacidosis. Methods Aimed at this issue through our department, 105 cases ketotic onset of the newly diagnosed diabetic patients were retrospectively analyzed, lipid profile, random blood glucose ,glycated hemoglobin, islet function, glutamic acid decarboxylase antibody, protein tyrosine phos- phatase antibody were measured. According to autoimmune antibodies and islet function, the cases were di- vided into three groups, A group contains 46 cases of patients with positive islet auto-antibodies ; B group contains 10 cases of patients with negative islet auto-antibodies and fine islet function;C group contains 49 cases of patients with negative islet auto-antibodies and poor islet function ; According to the waist circum- ference and BMI the cases were divided into is divided into two groups, Obese group 60 cases, non obese group 45 cases. After six months of strengthening control blood sugar with insulin, review the blood glu- cose, glycosylated hemoglobin, pancreatic function, while observing the dependence on insulin. Results In the age, BMI ,random glucose level and HbAlc, the significant difference was found between Group C and A （P 〈 0.01 ）, Group C and B （P 〈 0.01 ）. In TG, HDL-c the significant difference was found between Group C and A （ P 〈 0.01 ）, pancreatic islets function in group C were significantly higher than that in group A and B（P 〈0.01 ） ,after six months of 93.87% patients of group C can keep blood glucose at target levels without insulin therapy, Compared with the normal weight group,the patients in obese group had less severe insulin deficiency when ketosis or ketoacidosis occurred, their serum TC ,TG were higher,positive rate of is- let autoantibodies were lower, and βcells reserve functions are better. Conclusion Diabetic patients with ketosis-onset have different clinical characteristics. Auto-antibodies and β-cell functional reserve may help to identify the subtype s of diabetes. Islet function dynamic observations can help points type diagnosis.