暴发性1型糖尿病和经典自身免疫性1型糖尿病的临床特征比较研究

Comparison of Clinical Features between Fulminant Type 1 Diabetes and Classical Autoimmune Type 1 Diabetes

本研究回顾分析四川大学华西医院2005年10月2011年10月间收治的因酮症或酮症酸中毒入院的1 265例糖尿病患者,其中8例符合暴发性1型糖尿病(F1D)诊断标准。分析总结了该8例F1D患者的临床特征,并与16例同期以酮症酸中毒为首发症状入院,且性别、年龄匹配的经典自身免疫性1型糖尿病(T1D)患者进行病例对照研究。6年间,本院收治的F1D患者占所有酮症或酮症酸中毒入院患者的6.3‰(8/1265),年龄(30.1±9.7)岁,病程(4.0±2.4)d。8例F1D患者中,5例患者起病前出现流感样前驱症状,7例出现消化道症状。与自身免疫性T1D相比,F1D患者出现流感及消化道等前驱症状的频率更高,入院时血糖更高(P<0.01),糖化血红蛋白(HbA1c)却明显偏低(P<0.05),而空腹及餐后C肽释放水平更低,酸中毒及电解质紊乱更加严重。本研究数据显示,与自身免疫性T1D患者相比,F1D患者入院时有更复杂多变的临床症状,表现为更严重的高血糖、胰岛素缺乏及水电解质酸碱失衡。目前F1D诊断标准是否适合中国人群以及其敏感性与特异性仍亟待多中心大型临床调查进一步证实。

The data of 1,265 in-patients with diabetic ketosis or ketoacidosis treated in West China Hospital from October 2005 to October 2011 were analyzed retrospectively, and 8 of whom met fulminant type 1 diabetes （FID） diagnostic criteria. The clinical features of the 8 F1D patients were investigated and compared with other 16 newly diagnosed autoimmune type 1 diabetes （T1D） patients, gender- and age-matched and with acute onset of ketoacidosis. During the six years between 2005 and 2011, the incidence of F1D was 6.3~0 （8/1265） among all patients with dia- betic ketosis or ketoacidosis admitted to the West China Hospital. The averaged age of the patients at onset of F1D was （30.1±9.7） years old, and the duration of diabetes was （4.0±2.4） days. Five of the 8 F1D patients had flu- like symptoms, and 7 had gastrointestinal symptoms. Blood glucose of F1D patients on admission was significantly higher than that of autoimmune T1D patients （P〈0.01）, while the glycated hemoglobin （HbAlc） was lower than that of autoimmune T1D patients （P〈0.01） . Additionally, fasting and postprandial C-peptide was significantly lower in F1D patients, with more severe acidosis, electrolytes and acid-base disturbances. The data suggest,that, compared with the autoimmune TID patients, F1D patients have more complicated and more severe clinical manifestation with more severe hyperglycemia, more significant insulin deficiency and more obvious fluid electrolytes and acid-base disturbances. However, the sensitivity and the specificity of the diagnostic criteria of FID are still needed to be improved for the Chinese people, so more multi-center and large-scale clinical trials should be conducted in the future.