暴发1型糖尿病的临床特征

Clinical characteristics of fulminant Type 1 diabetes mellitus

目的:对比分析1型糖尿病(Type 1 diabetes mellitus,T1DM)与暴发1型糖尿病(fulminant Type 1 diabetes mellitus,FT1DM)的临床资料,找出FT1DM患者临床生化指标的差异,减少医务人员对FT1DM的漏诊、误诊及误治。方法:对2012年6月至2018年12月期间长沙市中心医院内分泌科收治的T1DM患者进行回顾性分析,共纳入T1DM患者101例(其中FT1DM 8例)。分析FT1DM患者的临床资料,并将其与纳入的经典T1DM患者的临床资料进行比较。结果:8例FT1DM患者均成年起病,发病年龄为(30.25±5.28)岁,起病1周内均发生严重糖尿病酮症酸中毒,胰岛功能衰竭,胰岛相关自身抗体均阴性,均伴有胰酶水平升高。与经典T1DM比较,FT1DM患者起病时血糖水平更高[(41.89±12.54)mmol/L vs(22.57±9.74)mmol/L],糖化血红蛋白(glycosylated hemoglobin,HbA1c)更低[(6.08±0.41)%vs(10.87±2.46)%],空腹C肽水平更低[(0.02±0.00)nmol/L vs(0.03±0.06)nmol/L,均P<0.05]。结论:FT1DM起病急骤,以糖尿病酮症酸中毒起病,起病时血糖水平比经典T1DM更高,伴有电解质紊乱、肾功能受损,部分合并肝功能受损,伴消化道症状及胰酶水平升高;无性别差异;起病年龄不等,以青少年和成人居多;妊娠妇女为高危人群。FT1DM终身依赖胰岛素治疗,应引起临床工作者的重视。

Objective:To compare the differences in clinical characteristics between Type 1 diabetes mellitus(T1DM)and fulminant Type 1 diabetes mellitus(FT1DM),and to reduce the missed diagnosis,misdiagnosis,and mistreatment of FT1DM by medical staff.Methods:A total of 101 hospitalized patients with T1DM(including 8 cases of FT1DM)were enrolled in this study from Changsha Central Hospital between June 2012 and December 2018.Clinical characteristics of the 8 FT1DM patients were collected and compared with all T1DM patients.Results:All FT1DM patients were adult with the average age of(30.25±5.28)years old,accompanied by severe diabetic ketoacidosis(DKA)occurred within 1 week after onset.Moreover,pancreatic beta cells in these patients were destroyed and the islet-related antibodies were negative,while the serum pancreatic enzyme levels were increased.Compared with classic T1DM patients,the plasma glucose levels in FT1DM patients were much higher[(41.89±12.54)mmol/L vs(22.57±9.74)mmol/L],but glycosylated hemoglobin(HbA1c)and fasting C peptide levels were significantly lower[(6.08±0.41)%vs(10.87±2.46%)%,P<0.05]and[(0.02±0.00)nmol/L vs(0.03±0.06)nmol/L,P<0.05].Conclusion:The onset time of FT1DM patients is very urgent via driving DKA.These patients have higher blood glucose concentration than classic T1DM patients,accompanied by electrolyte disturbances,impaired renal function,partially impaired liver function,as well as gastrointestinal symptoms and elevated trypsin.Most FTDM patients are adolescents and adults with no gender difference,especially pregnant women who are at high risk.Lifelong insulin dependence in FT1DM patients should be paid more attention in clinical treatment.