暴发性1型糖尿病与经典1型糖尿病临床特征比较

Comparison in clinical characteristics between fulminant type 1 diabetes and classical type 1 diabetes

目的分析暴发性1型糖尿病(fulminant type 1 diabetes,FT1DM)与经典1型糖尿病(T1DM)的临床特征,以指导临床治疗。方法回顾性分析该院内分泌科2008年12月—2014年8月间以酮症酸中毒起病的暴发型1型糖尿病患者9例(FT1DM组)和初诊经典1型糖尿病患者23例(T1DM组)的临床特征,包括起病时间、年龄、性别、体重指数、流感样症状、妊娠人数、腹痛、入院时随机血糖、糖化血红蛋白、C肽、肌酐、血钾、动脉血p H、白细胞计数等,并用t检验和χ2检验分别对计量资料和计数资料进行统计分析。结果与经典1型糖尿病相比,暴发性1型糖尿病的年龄较大,起病时间明显缩短,入院时血糖更高,糖化血红蛋白较低,胰岛功能更差,血糖达标时间延长,妊娠期女性更多(P<0.05);暴发性1型糖尿病组患者较经典1型糖尿病组患者入院时肌酐及谷草转氨酶显著升高,血钠水平降低,酸中毒明显(均P<0.05或P<0.01)。结论暴发性1型糖尿病患者起病更急,代谢紊乱更严重,熟悉其临床特征有利于早期临床治疗,改善预后。

Objective To analyze the clinical features of fulminant type 1 diabetes （FT1 DM）and classical type 1 diabetes and to guide the clinical treatment.Methods Retrospective analysis was made of the patients admitted to The Second Affiliated Hospital of Anhui Medical University from December 2008 to August 2014 with the onset of the ketoacidosis,9 cases of patients with fulminant type 1 dia-betes （FT1 DM group）and 23 cases of patients with classical type 1 diabetes （T1 DM group）.Clinical features including onset time, age,gender,body mass index,flu-like symptoms,the number of pregnancy,abdominal pain,blood glucose,HbA1 C,C peptide,creati-nine,blood potassium,blood gas analysis,blood white cell count,et al.were analyzed.χ2 or t test was used for data analysis.Results In comparison with T1DMgroup,the age and the blood glucose of FT1DMgroup were higher,the onset time was shorter,the HbA1C and C peptide was lower,the time of the blood glucose reaching the standard was longer,the number of pregnant women was more （P〈0.05）.The creatinine of the FT1DMgroup was higher than the T1DMgroup,the aspartate aminotransferase was also increased,blood sodium was lower,and ketoacidosis was more serious（P〈0.05 or P〈0.01 ）.Conclusion Fulminant type 1 diabetes showed shorter onset time and severer metabolic derangements than classic type 1 diabetes.Being familiar with the clinical features can help us to treat it in time,and improve the prognosis of patients.