儿童与青少年暴发性1型糖尿病与经典1型糖尿病的区别

Differences between classic type 1 diabetes and fulminant type 1 diabetes in children and adolescents

目的 通过总结儿童与青少年暴发性1型糖尿病（FT1DM）和经典1型糖尿病（T1DM）发病情况及临床特点,了解两者有无区别.方法 研究2004年1月至2012年12月在首都医科大学附属北京儿童医院新诊断的T1DM患儿的特点,筛选出FT1DM作为组A,并按照起病急缓分对照组：组B为10 d内以酮症（DK）或酮症酸中毒（DKA）起病的经典T1DM,组C为30 d以内的经典T1DM,比较FT1 DM与经典T1DM的区别.结果 9年新诊断T1DM患儿853例,其中组A11例,组B 117例,组C 565例.FT1DM占所有新诊断T1DM的1.29％,占病史30 d以内的经典T1DM的1.95％.3组患儿除在发病年龄[1.33（0.95 ～9.25）岁比6.85（3.72～ 10.59）岁比7.00（4.00 ～ 10.08）岁,P=0.043]、体质量指数[16.89（15.63 ～ 19.74） kg/m^2比14.49（13.46 ～ 16.19） kg/m^2比14.79（13.60 ～ 16.38） kg/m^2,P=0.004]、发病前流感样症状发生率（82％比47％比42％,P=0.000）、腹部症状发生率（55％比21％比16％,P=0.002）、糖化血红蛋白（HbA1c）[（7.3±1.0）％比（11.7±2.0）％比（11.8±2.3）％,P =0.000]、碳酸氢根（HCO3-）[8.20（3.10 ～ 16.85）比15.05 （10.13 ～21.10）比17.50（9.65 ～22.55）,P=0.022]、天冬氨酸转氨酶[30（26～33） U/L比21（15～27） U/L比22（18～29） U/L,P=0.010]方面差异有统计学意义外,余无明显统计学及临床差异.发病前流感样症状和腹部症状常见,在急性合并症、随访胰岛素用量及血糖控制状况方面,FT1DM并未显示出与经典T1DM明显的差异.结论 儿童与青少年FT1DM发病率极低,与经典T1DM无明显区别.

Objective To understand whether fulminant type 1 diabetes mellitus （FT1DM） is different from classic type 1 diabetes mellitus（T1DM） in children and adolescents by summarizing the incidence and clinical characte-ristics of the 2 types of diabetes mellitus.Methods To study the characteristics of newly diagnosed T1DM patients hospitalized at Beijing Children＇s Hospital,Capital Medical University from January 2004 to December 2012,cases of FT1DM were screened as group A.And according to the rapid or slow onsets,patients were divided into 2 control groups：group B had classic T1DM onset with diabetes ketosis（DK） or diabetes ketoacidosis（DKA） within 10 days,and group C had classic T1DM within 30 days,while the differences were compared between FT1DM and classic T1DM.Results Eight hundred and fifty-three cases were diagnosed as T1DM in the past 9 years,including 11 cases in group A,117 cases in group B and 565 cases in group C.FT1DM accounts for 1.29% of all newly diagnosed T1DM and 1.95% of classic T1DM within 30 days.In addition,onset age [1.33 （0.95-9.25） years old vs 6.85 （3.72-10.59） years old vs 7.00 （4.00-10.08） years old,P =0.043],body mass index [16.89（15.63-19.74） kg/m^2 vs 14.49（13.46-16.19） kg/m^2 vs 14.79（13.60 ～ 16.38） kg/m^2,P =0.004],incidence of flu-like symptoms（82% vs 47% vs 42%,P =0.000）,abdominal symptoms before onset（55% vs 21% vs 16%,P =0.002）,glyeosylated hemoglobin（HbA1c） [（7.3 ± 1.0）% vs （11.7 ±2.0）% vs （11.8 ± 2.3）%,P =0.000],HCO3 [8.20（3.10-16.85） vs 15.05（10.13-21.10） vs 17.50（9.65-22.55）,P =0.022],aspartate aminotransferase [30（26-33） U/L vs 21 （15-27） U/L vs 22（18-29） U/L,P =0.010] of three groups had statistical differences,while the others had no statistical or clinical differences.Flu-like symptoms and abdominal symptoms before onset were common,and in the aspects of acute complications,insulin dosage and glucose control during follow-up,FT1DM showed no obvious differences from classic T1DM.Conclusions Incidence of FT1DM in children and adolescents was very low,and no apparent differences were found between FT1DM and classic T1DM.