2型糖尿病合并暴发性1型糖尿病一例并文献复习:双重糖尿病?

Double diabetes: type 2 diabetes mellitus combined with fulminant type 1 diabetes mellitus: a case report and literature review

目的分析2型糖尿病(T2DM)合并暴发性1型糖尿病(FT1DM)与单纯性FT1DM的临床特点。方法报道1例T2DM合并FT1DM的病例,分析其病例特点,并比较文献中21例T2DM合并FT1DM与日本161例单纯性FT1DM及国内70例单纯性FT1DM患者的临床特点,组间比较采用t检验。结果(1)T2DM合并FT1DM患者以男性居多(男女比例14∶7),平均年龄(60.1±11)岁,FT1DM病程(4.4±1.7)d,所有患者胰岛自身抗体[谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)]阴性。(2)与日本单纯性FT1DM相比,T2DM合并FT1DM患者年龄更大[(60.1±11.8)比(39.1±15.7)岁,P<0.001]、糖化血红蛋白(HbA1c)水平更高(8.2%±1.6%比6.4%±0.9%,P<0.001)、体质指数(BMI)更高[(23.7±5.7)比(20.7±3.9)kg/m2,P=0.032]。(3)与国内单纯性FT1DM相比,差别趋势与日本单纯性FT1DM比较一致。T2DM合并FT1DM患者年龄更大[(60.1±11.8)比(31.7±11.4)岁,P<0.001],HbA1c水平更高(8.2%±1.6%比6.8%±1.1%,P<0.001),同时有更长的病程[(4.4±1.7)比(3.1±2.4)d,P=0.032];BMI差异无统计学意义[(23.7±5.7)比(21.1±3.7)kg/m2,P=0.068]。结论双重糖尿病可以表现为T2DM合并FT1DM,其相较单纯性FT1DM表现为更长的病程、更大年龄、更高的BMI和HbA1c水平。

Objective To investigate and compare clinical features between type 2 diabetes mellitus (T2DM) combined with fulminant type 1 diabetes mellitus (FT1DM) and simple FT1DM. Methods A case of T2DM combined with FT1DM was reported, and the clinical features of T2DM combined with FT1DM were summarized and analyzed. The clinical characteristics between 21 T2DM combined with FT1DM patients and 161 simple FT1DM patients from Japan and 70 simple FT1DM patients from China were compared, and a t test was used for the comparisons. Results (1) Most patients with T2DM combined with FT1DM were male (male∶female was 14∶7) and old. The course of FT1DM was (4.4±1.7) days. All patients had negative islet autoantibodies.(2) Compared with simple FT1DM from Japan, patients with T2DM combined with FT1DM were older [(60.1±11.8) vs (39.1±15.7) years, P<0.001], had higher glycated hemoglobin A1c (HbA1c) levels (8.2%±1.6% vs 6.4%±0.9%, P<0.001), and were more obese [body mass index (BMI) was (23.7±5.7) vs (20.7±3.9) kg/m2, P=0.032].(3) Compared with domestic FT1DM, the difference was similar, patients with T2DM combined with FT1DM were older [(60.1±11.8) vs (31.7±11.4) years, P<0.001], had higher HbA1c levels (8.2%±1.6% vs 6.8%±1.1%, P<0.001), and had longer course of disease [(4.4±1.7) vs (3.1±2.4) d, P=0.032], but there was no statistically significant difference in BMI [(23.7±5.7) vs (21.1±3.7) kg/m2, P=0.068]. Conclusion Double diabetes can be manifested as T2DM combined with FT1DM, which is characterized by a longer course of disease, older age, higher BMI and HbA1c level compared with simple FT1DM.