青年起病非典型糖尿病的临床特征分析

Analysis of clinical characteristics in young-onset atypical diabetes mellitus

目的探讨非典型糖尿病（ADM）青年患者的临床特征。方法回顾性分析340例发病年龄≤40岁的糖尿病患者的病例资料。通过详细病史收集、体格检查及实验室检测,排除典型的1型糖尿病、2型糖尿病及其他类型糖尿病,共有20例患者符合ADM诊断标准。对该组患者的发病特点、胰岛β细胞功能变化及糖脂代谢指标进行分析。结果在青年起病的ADM患者中,男性多发（男∶女=18∶2）;且新诊断的糖尿病及家族史比例偏高,分别占80.0%和70.0%。ADM患者空腹及餐后2 h C肽均介于1型及2型糖尿病患者之间。此外,ADM患者的Hb A1c及尿酸高于2型糖尿病患者（P=0.000,P=0.001）,而三酰甘油高于1型糖尿病患者（P=0.002）。在6～12个月的随访过程中,19例患者（占95.0%）终止胰岛素治疗;其中12例患者（占60.0%）仅靠控制饮食及运动即可维持血糖水平正常。结论青年ADM患者以男性多见,多为新诊断糖尿病患者且多有糖尿病家族史,常伴有脂代谢异常,胰岛β细胞功能修复能力较好。

Objective To explore the clinical characteristics in youth patients with atypical diabetes mellitus（ AD M）. Methods Medical records of 340 diabetic patients with the age of onset ≤ 40 years were retrospectively analyzed. T ypical type 1, type 2, and other types of diabetes were excluded via m edical history collection, physical exam ination, and laboratory exam inations. Atotal of 20 patients m et the diagnostic criteria of AD M. Their onset characteristics, changes in islet β-cell function, and indexes for glucolipid metabolism were analyzed. Results T he m ajority of young ADM patients were m ale（ male： fem ale = 18∶ 2）. The percentages of patients with new-onset diabetes and a fam ily history were high and accounted for 80. 0% and 70. 0%,respectively. Fasting C-peptide level and the C-peptide level 2 h after dinner in AD M patients were between those in patients w ith type 1 diabetes and type 2 diabetes. Besides, ADM patients had higher H b A1 cand uric acid（ U A） levels as compared with patients with type 2 diabetes（ P = 0. 000, P = 0. 001） and higher triglyceride（ T AG） level as com pared with patients with type 1 diabetes（ P = 0. 002）. Nineteen patients（ 95. 0%） stopped the insulin therapy during 6- 12 m onths of follow-up. Among them, 12（ 60. 0%） were able to maintain the normal blood glucose just relying on diet and exercise. Conclusion The majority of young AD M patients are m ale. Most patients have new diagnosed diabetes and a family history. The lipid m etabolism dysfunction is com m on in young AD M patients and their ability to repair islet β-cell function is favorable.