2010～2012年儿童及青少年新发病1型糖尿病患者合并酮症酸中毒的情况调查

Ketoacidosis in newly-onset type 1 diabetes mellitus in children and adolescents from 2010 to 2012

目的：调查本院新发病1型糖尿病患儿起病时合并酮症酸中毒（ DKA）的情况及其相关因素。方法回顾性分析本院2010年至2012年新诊断的317例1型糖尿病患者,调查以住院为基础的DKA发生情况,分析DKA的发生与性别、年龄、居住地、家族史、症状持续时间、误诊或漏诊及延迟治疗的关系。其中,根据年龄将患者分为2组：组1为年龄〈5岁者；组2为≥5岁的患者。结果317例1型糖尿病患者中有175例（55.2%）是以DKA起病的,轻、中、重度DKA分别占26.5%、23.9%、49.6%。组1和组2的DKA比例分别为67.5%、48.0%（P=0.001）；其中,年龄〈2岁为70.3%。组1的重度DKA所占比例显著高于组2（60.0%对41.3%,P=0.048）；2组患者的误诊或漏诊率分别为27.4%、12.0%（P=0.001）,〈2岁者高达37.8%；组1的HbA1C水平低于组2（11.50%对12.54%,P=0.001）；组1的急性代谢紊乱期C肽及蜜月期C肽均低于组2[（0.36对0.55）ng/ml,P=0.001；（0.40对0.61）ng/ml,P=0.02]。有误诊或漏诊的患者DKA频率显著增高（83.9%对49.0%,P=0.000）。相较于无DKA者,起病时合并DKA者急性代谢紊乱期的C肽值低[（0.56对0.40） ng/ml,P〈0.01],进入蜜月期后二者的C肽值差异无统计学意义[（0.67对0.59）ng/ml,P=0.22]。 Logistic回归提示DKA的发生仅与年龄、误诊或漏诊相关,即≥5岁者发生DKA的概率是〈5岁者的一半（OR=0.448,P=0.003）,存在误诊或漏诊的患者发生DKA的危险度高于无误诊或漏诊的患者（OR=5.640,P=0.005）。结论本院1型糖尿病患者起病时DKA的发生率高,且以重度为主。 DKA多因素分析提示年龄〈5岁、存在误诊或漏诊是发生DKA的危险因素。

Objective To investigate the incidence of newly-onset type 1 diabetes mellitus （ T1DM ） complicated with ketoacidosis（DKA） and its relevant factors in pediatrics. Methods Hospital records of 317 T1DM children below 18 years of age, diagnosed from 2010 to 2012 were reviewed. By using retrospectively analyzed data of inpatients with newly-diagnosed T1DM, the incidence of DKA was calculated. In this study, the influential factors of DKA included gender, age, residence, family history of diabetes mellitus, duration of symptoms, misdiagnosis or missed diagnosis, and delayed treatment. Patients were divided into two groups：group 1, aged〈5 year and group 2, aged〉5 year. Results Of all patients diagnosed with T1DM, 175 （ 55. 2%） presented with DKA, and mild, moderate, and severe DKA accounted for 26. 5%, 23. 9%, 49. 6%, respectively. The incidences of DKA in group 1 andgroup2were67.5% and48.0% （P=0.001）,withthehighestfrequency（70.3%）inpatientsaged〈2 years. The proportion of severe DKA in group 1 was significantly higher than that of group 2 （60. 0% vs 41. 3%, P=0. 048）. The rates of misdiagnosis and missed diagnosis in the two groups were respectively 27. 4% and 12. 0%（P=0. 001）, being 37. 8% in children〈2 years. The HbA1C level of group 1 was lower than group 2 （11. 50% vs 12.54%,P=0.001）. Intheacutemetabolicandhoneymoonperiod,Cpeptidelevelsofgroup1werebothlowerthan those of group 2 [（0. 36 vs 0. 55） ng/ml, P=0. 001;（0. 40 vs 0. 61） ng/ml, P=0. 02]. The DKA incidence of patients with misdiagnosis or missed diagnosis was significantly increased（83. 9% vs 49. 0%, P=0. 000）. Compared with those without DKA, C peptide level of patients with DKA was lower in the acute metabolic period[（0. 56 vs 0.40）ng/ml,P〈0. 01], but no difference in honeymoon period[（0. 67 vs 0. 59）ng/ml,P=0. 22]. Logistic regression showed that age, misdiagnosis or missed diagnosis were associated with the presence of DKA. The＆amp;nbsp;possibility of the occurrence of DKA in patients aged〉5 years was half of patients aged〈5 years （ OR=0. 448, P=0. 003）, and the risk of DKA in patients with misdiagnosis or missed diagnosis was higher （OR=5. 640, P=0. 005）. Conclusion DKA in patients with newly-onset T1DM is frequent and often severe. Multivariate analysis revealed that patients aged 〈5 years and those with misdiagnosis or missed diagnosis are encountered high risk of DKA.