暴发性1型糖尿病的临诊应对

Approach to the patient with fulminant type 1 diabetes

暴发性1型糖尿病（FT1D）是鉴别出来的一种特发性1型糖尿病的新亚型，主要临床表现为起病急骤，胰岛β细胞迅速破坏，出现高血糖症状1周内即发生糖尿病酮症或糖尿病酮症酸中毒，发病时血糖很高而HbA1c多接近正常，常伴血清胰酶水平升高。发病前多有类感冒样或胃肠道症状。本病具体发病机制尚未完全明确，可能在遗传背景基础上与病毒感染、自身免疫及妊娠等有关。本文报道2例FT1D，并对其临床特点、诊断、治疗等做一文献复习。

Fulminant type 1 diabetes （FF1D） has been identified as a new subtype of idiopathic diabetes. FT1D is characterized by abrupt and complete destruction of pancreatic β cells, with diabetic ketosis or diabetic ketoacidosis occurring within a week after the onset of hyperglycemic symptoms. At the time of initial presentation, plasma glucose level is increased, with near normal HbAlc. Serum pancreatic enzyme is elevated in the majority of patients with FT1D. Flu-like symptoms or gastrointestinal symptoms precede disease onset in most of patients. However, the pathogenesis of this disease remains unclear. Factors such as viral infection, autoimmune, and pregnancy based on the background of genes may account for FT1D. We herewith report two cases of FT1 D, and review its clinical features, diagnosis, and treatment.