以意识障碍或惊厥为首发症状的儿童低血糖症临床特点和误诊分析

Clinical features and causes of misdiagnosis of hypoglycemia first presented as disturbance of consciousness or seizures in children

目的探讨以意识障碍或惊厥为首发症状的小儿低血糖症的临床特点,重点探讨其病因谱和误诊原因。方法对18例住院治疗的低血糖患儿的临床资料进行分析。结果婴儿期发病最常见(10例,55.6%)。病因明确者10例:酮症性低血糖5例、胰岛β细胞增生1例、胰岛β细胞瘤1例、糖原累积症Ⅰ型2例、生长激素缺乏1例;未明确8例,其中6例高度怀疑遗传代谢病。误诊疾病主要为癫痫(10例,55.6%)。结论此病发病年龄以婴幼儿为主,病因以酮症性低血糖、高胰岛素血症及糖原累积症Ⅰ型相对常见。对于儿童不明原因的惊厥发作或意识障碍,应重视低血糖的可能。

Objective The present study was to summarize the clinical findings and to explore the causes of misdiag-nosis of hypoglycemia with onset symptoms of consciousness disturbances or seizures in children. Method Eighteen children of hypoglycemia with onset symptom of seizures or disturbance of consciousness were collected at the De-partment of Pediatrics, Peking University First Hospital. The clarified etiology, clinical features and reasons of misdi-agnosis were analyzed. Result Age at onset：infants younger than 1 year of age were most common in this group （ 10 cases,SS. 6% ）. Etiology：clear and definite in 10 cases, with ketotic hypoglycemia in 5, islet 13-cell hyperplasia in 1 ,islet β-cell tumor in 1 ,glycogen storage disease type I in 2, and growth hormone deficiency in 1 ;unclear in 8 ca-ses, with 6 of whom inborn errors of metabolism were highly suspected. Misdiagnosis ： most patients （ 10 cases, 55.6% ） were misdiagnosed as epilepsy. Conclusion Hypoglycemia in this group mainly occurred in infancy. Ketotic hypoglycemia,hyperinsulinism, and glycogen storage disease typeIare relatively common. Hypoglycemia should be a- mong, the list of differential differential diagnosis in children with seizures or consciousness disturbances of undetermined origin.