婴幼儿1型糖尿病27例临床分析

Clinical analysis of 27 cases with infantile diabetes

目的探讨婴幼儿糖尿病的临床特征、诊断及其治疗情况。方法对2014年4月至2016年6月期间郑州大学附属儿童医院收治的27例婴幼儿1型糖尿病(T1DM)的临床资料进行回顾性分析。并利用SPSS16.0统计软件对相关数据进行t检验和χ^2检验。结果婴幼儿糖尿病的发病年龄为1岁~3岁7个月;男15例,女12例;发病季节以冬春季发病为主;剖宫产组空腹血糖明显高于自然生产组(P<0.05);发病前并发呼吸道感染12例(44.44%),其中病原学检测6例为病毒,以柯萨奇病毒为主。以多饮、多尿为主诉入院14例,以发热、咳嗽伴精神差6例,以血糖升高7例;16例合并糖尿病酮症酸中毒男10例(62.50%),女6例(37.50%),其中男性糖尿病患儿中糖尿病酮症酸中毒发生率高于女性(62.50% vs 37.50%,χ^2=6.49,P<0.05)。合并肝功能、血脂异常2例;心肌酶异常7例;甲状腺功能异常10例,电解质异常26例,其中以低钠血症为主;抗胰岛素抗体阳性2例,抗谷氨酸脱羧酶抗体阳性5例。入院前发生首诊误诊13例(35.14%),误诊支气管肺炎6例,中枢神经系统感染、败血症各3例,心肌炎1例。均给予胰岛素治疗,经7~10 d治疗,患儿病情好转出院后继续治疗。结论婴幼儿T1DM起病的临床表现不典型,易合并酮症酸中毒,感染可能是患儿出现糖尿病酮症酸中毒的重要诱因之一。当患儿存在感染且血糖值较高时应注意糖尿病酮症酸中毒发生可能,避免误诊。

Objective To investigate the clinical features, diagnosis and treatment of infantile diabetes. Methods The clinical data of 27 infants with type 1 diabetes (T1DM) admitted to our hospital from Apr. 2014 to Jun. 2016 were retrospectively analyzed. SPSS16.0 statistical software was used to carry out t test and chi-square test on relevant data. Results The onset age of diabetes in infants and young children was 1 year to 3 years and 7 months. There were 15 males and 12 females. The onset season was mainly in winter and spring. The fasting blood glucose in cesarean section was significantly higher than that in natural production group (P<0.05). 12 cases (44.44%) were complicated with respiratory infections before the onset of the disease, including 6 cases of pathogenic detection of viruses, mainly Coxsackie virus. Among them, 14 cases were admitted to hospital with polydipsia and polyuria, 6 cases had fever, cough and mental retardation, 7 cases had elevated blood glucose, 16cases (62.50%) and 6 cases of women with diabetic ketoacidosis (37.50%). The incidence of diabetic ketoacidosis in male diabetic patients was higher than that in females (62.50% vs 37.50%,χ2=6.49, P<0.05). With abnormal liver function and dyslipidemia in 2 cases;myocardial enzyme abnormality in 7 cases;abnormal thyroid function in 10 cases;26 cases of electrolyte abnormality, mainly hyponatremia;2 cases of positive anti-insulin antibody and 5 cases of positive glutamic acid decarboxylase antibody. Before admission, 13 (35.14%) cases were misdiagnosed, 6 cases were misdiagnosed as bronchopneumonia, 3 cases were misdiagnosed as central nervous system infection, 3 cases were sepsis and 1 case was myocarditis. All patients were treated with insulin. After 7 to 10 days of treatment, the patient’s condition improved and continued to be treated at home. Conclusions The clinical manifestations of infantile T1DM onset are not typical, and it is easy to be associated with ketoacidosis. Infection may be one of the important causes of diabetic ketoacidosis. When the child has an infection and the blood sugar level is high, attention should be paid to the occurrence of diabetic ketoacidosis, to avoid misdiagnosis.