13例暴发性1型糖尿病临床特点分析

Clinical Characteristics of Fulminant Type 1 Diabetes Mellitus:an Analysis of 13 Cases

目的探讨暴发性1型糖尿病(FT1DM)的临床特点。方法回顾性分析2014—2019年南昌大学第一附属医院收治的13例FT1DM患者的临床资料,分析其临床特点。结果13例FTIDM病例,男4例、女9例,均呈超急性起病,病程为(3.46±2.11)d,5例有发热,1例出现呼吸道症状,6例伴有腹痛,10例出现恶心呕吐,仅1例有糖尿病家族史;发病时血糖显著升高,达(34.51±7.24)mmoL·L^-1,糖化血红蛋白接近正常,达(6.96±0.57)%,空腹C肽降低,达(0.10±0.06)ng·mL^-1,餐后2 h C肽降低,达(0.11±0.06)ng·m L^-1,动脉血pH值提示酸中毒,达(7.09±0.13),多有低T3综合征表现,可合并多种严重并发症如肝肾功能损害、横纹肌溶解、心脏骤停等。结论FT1DM以超急性起病、严重代谢紊乱为特点,常合并多系统损害。

Objective To analyze the clinical characteristics of fulminant type 1 diabetes mellitus(FT1DM).Methods Clinical data of 13 FT1DM patients admitted to the First Affiliated Hospital of Nanchang University from 2014 to 2019 were analyzed retrospectively.Results All patients(4 males and 9 females)presented with abrupt onset,with a disease duration of(3.46±2.11)days.Among the 13 patients,5 had fever,1 had respiratory symptoms,6 had abdominal pain,10 had nausea and vomiting,and only 1 had a family history of diabetes.At the onset of FT1DM,blood glucose level increased to(34.51±7.24)mmol·L^-1,glycosylated hemoglobin level was close to normal(6.96±0.57)%,fasting C-peptide level decreased by(0.10±0.06)ng·mL^-1,and 2-hour postprandial C-peptide level decreased by(0.11±0.06)ng·mL^-1.Arterial pH indicated an acidosis(7.09±0.13).Most of these patients had low-T3 syndrome,which could be combined with a variety of serious complications such as hepatorenal impairment,rhabdomyolysis and sudden cardiac arrest.Conclusion FT1DM is characterized by hyperacute onset and severe metabolic disorder and is often complicated by multiple system damage.