儿童糖尿病合并酮症酸中毒和高血糖高渗状态临床特征分析

Clinical features of new-onset diabetes complicated by a combination of diabetic ketoacidosis and hyperglycemia hyperosmolar syndrome in children

目的了解儿童糖尿病合并酮症酸中毒(DKA)和高血糖高渗状态(HHS)的临床特征。方法依据诊断标准,从1995年1月至2009年12月新确诊的糖尿病患儿中筛选DKA和HHS患儿,比较糖尿病同时合并DKA和HHS(DKA-HHS)与单纯DKA患儿的临床特点。结果 1 065例新诊断儿童糖尿病患儿中有483例合并DKA,占45.35%;16例符合DKA-HHS,占1.50%;无单纯HHS糖尿病患儿。HHS在DKA患儿中的发生率为3.31%,其中1型糖尿病14例,2型糖尿病2例。HHS在年龄≥10岁的DKA患儿中的发生率明显高于小年龄患儿(χ2=6.05,P<0.05)。DKA-HHS患儿中重度脱水的比例、平均有效渗透压、血糖、三酰甘油及尿素氮水平均显著高于单纯DKA患儿,且酸中毒程度明显重于单纯DKA患儿,差异均有统计学意义(P均<0.05);DKA-HHS患儿的校正血清钠水平显著高于单纯DKA患儿,差异有统计学意义(P<0.05)。结论新诊断糖尿病患儿的HHS发生率较DKA低,且均与DKA合并存在;更常见于≥10岁患儿;DKA-HHS较单纯DKA患儿的代谢紊乱程度、脱水及酸中毒程度更严重,肾功能异常率更高。

Objective To investigate the clinical features of new-onset diabetes complicated with ketoaeidosis （DKA） and hyperglycemia hyperosmolar syndrome （HHS） in children. Methods From children diagnosed of diabete in Jan 1995 to Dec 2009, the patients with DKA and/or HHS were selected according to the guideline. The patients were divided into simple DKA group and DKA accompanied by HHS group （DKA-HHS） and the clinical features were compared. Results A total of 1065 pediatric diabetes were included in study, of whom 483 patients （45.35%） were diagnosed with DKA and 16 （1.50%） met the criteria for HHS. All HHS were accompanied by DKA. HHS accounted for 3.31% of 483 DKA cases. Of them, 14 were type 1 diabetes and 2 were type 2 diabetes. The incidence of HHS was higher in the patients over ten years older than younger patients （P〈0.05）. The proportion of moderate and severe dehydration, blood glucose level, effective osmotic pressure, triglyceride, urea nitrogen and the degree of acidosis were much higher in DKA-HHS group than simple DKA group （all P=0.00）. The calculated corrected sodium was higher in DKA- HHS group than simple DKA group （P=0.00）. Conclusions The incidence of HHS was much lower in diabetic children than that of DKA. HHS was usually accompanied by DKA. Patients with DKA-HHS had more severe metabolic disorders, hydration, acidosis and renal dysfunction thanthose with DKA only.