初发1型糖尿病患儿酮症酸中毒的调查

An investigation of ketoacidosis in children with newly diagnosed type 1 diabetes

目的调查初发1型糖尿病患儿酮症酸中毒(DKA)的发生情况。方法以224例初发1型糖尿病患儿为研究对象,进行回顾性分析,分为DKA组和未合并DKA组,各112例。DKA组患儿根据年龄分为≥5岁组(65例)和<5岁组(47例),并根据酸中毒情况分为轻度(26例)、中度(29例)、重度(57例)3组。分析DKA发生的影响因素以及不同年龄DKA患儿的临床及实验室特点。结果 224例初发1型糖尿病患儿中最常见的症状为多饮(86.2%)、多尿(78.6%)及体重下降(57.1%)。与未合并DKA患儿比较,DKA组<5岁、低收入、父母教育程度高中及以下所占的比例均较高,随机血糖、Hb A1C水平较高,pH、HCO_3^-及C肽水平更低,差异均具有统计学意义(P<0.05)。≥5岁组与<5岁组的轻、中、重度DKA所占比例的差异无统计学意义(P>0.05)。与<5岁组相比,≥5岁组DKA患儿的症状持续时间较长,随机血糖较低,HbA1C、C肽水平较高,差异具有统计学意义(P<0.05)。结论 1型糖尿病患儿DKA发生率高,DKA的发生与年龄、父母文化程度及家庭收入有关。

Objective To investigate the incidence of diabetic ketoacidosis（DKA） in children with newly diagnosed type 1 diabetes. Methods A retrospective analysis was performed for the clinical data of 224 children with newly diagnosed type 1 diabetes, and according to the presence or absence of DKA, these children were divided into DKA group and non-DKA group, with 112 children in each group. The DKA group was further divided into ≥5-year group（65 children） and 5-year group（47 children）, and according to the blood gas parameters, this group was divided into mild group（26 children）, moderate group（29 children）, and severe group（57 children）. The factors influencing the development of DKA were analyzed, as well as the clinical and laboratory features of DKA children with different ages. Results The most common symptoms in these 224 children with type 1 diabetes were polydipsia（86.2%）, polyuria（78.6%）, and weight loss（57.1%）. Compared with the non-DKA group, the DKA group had a significantly higher percentage of children who were aged 5 years, who had low family income, or whose parents had an educational level of senior high school or below. The DKA group had significantly higher levels of random blood glucose and Hb A1 C and significantly lower levels of p H, HCO3^-, and C-peptide than the non-DKA group（P0.05）. There was no significant difference in the percentage of children with severe DKA between the ≥5-year group and the 5-year group（P0.05）. Compared with the 5-year group, the ≥5-year group sufferred from symptoms for a significantly prolonged period, and had a significantly lower level of random blood glucose and significantly higher levels of Hb A1 C and C-peptide（P0.05）. Conclusions DKA has a high incidence rate in children with type 1 diabetes, and the development of DKA is associated with age, parents＇ educational level, and family income.