探讨儿童及青少年暴发性1型糖尿病分型的临床意义

Clinical significance of typing fulminant type 1 diabetes in children and adolescents

目的 调查暴发性1型糖尿病（FT1D）的发病情况及临床特点,明确该亚型在儿童及青少年中分型的临床意义.方法 调查2004年1月至2012年12月我院新确诊的18岁以下1型糖尿病（T1D）患者,共853例,根据FT1D的诊断标准共筛出11例FT1D.依照相同性别、相近年龄（±2岁）、相同季节、相同年份在我院糖尿病病例库中按1：4的比例进行匹配,选取经典型T1D44例.总结两组的临床特点、实验室检查,随访至少1年的临床结局.结果 853例中,以酮症（DK）或酮症酸中毒（DKA）急性起病的经典1型者468例,符合FT1D诊断标准的患者11例（男孩6例）,暴发性占所有T1D的1.29％,占DK或DKA急性起病的T1D的2.35％.暴发组与经典组相比,除体质指数（BMI）差异有统计学意义外,在急重症并发症发生率、治疗后蜜月期发生率及持续时间、电解质紊乱程度等方面差异均无统计学意义.结论 18岁以下患者FT1D发生比例极低,与经典T1D相比,未显示出明显差异.但由于病例较少,需要积累数据进一步探究该亚型分型的临床意义.

Objective To investigate the frequency and clinical characteristics of fulminant type 1 diabetes （FT1 D） and to clarify the clinical significance of the subtype in pediatrics.Methods Case-control study designed and Data collected from hospitalized registration system.All new diagnosed type 1 diabetes （T1 D） patients from January 2004 to December 2012 were enrolled.According to the diagnostic criteria,we obtained 11 FT1D cases from 853 T1D,at the same time,we match the classical type as control group according to the same gender,age（± 2 years）,the same season and same year with a ratio of 1：4.We studied the clinical features,laboratory parameters and follow-up clinical outcome for at least one year in both groups.Results There were 468 classical type 1 diabetes patients onset with diabetic ketosis（DK） or diabetic ketoacidosis（DKA） among 853 cases.Eleven cases （6 boys） were in line with FT1D criteria.Frequency of FT1D accounted for 1.29％ of all classic T1D,and 2.35％ in T1D with DK or DKA onset.Compared with the classical group,fluminant group has no statistical significance in acute severe complications,the honeymoon rate and lasting period,abnormal electrolytes and etc,except body mass index （BMI）.Conclusions Frequency of FT1D below 18 years old is very low,ruminant group shows no obvious differences compared to the classical group.However,so rare FT1D cases,we must do further study in the future to explore the clinical significance of this subgroup in pediatrics.