中国暴发1型糖尿病患者临床特点的Meta分析

Clinical characteristics of Chinese patients with fulminant type 1 diabetes mellitus:a meta-analysis

目的系统评价我国暴发1型糖尿病(F1DM)的临床特征和预后。方法计算机检索CNKI、WanFang Data、CBM和PubMed数据库,搜集所有中国F1MD患者的病例系列研究,检索时限均从2000年1月1日至2022年3月30日。采用Stata 16.0和RevMan 5.3软件进行Meta分析。结果共纳入233个研究,包括874例患者,男性410例(46.91%),女性464例(53.09%),发病年龄为29.32±1.09岁,病程为3.74±0.63天,BMI为21.18±0.52 kg/m^(2),HbA1c为6.58%±0.08%,空腹C肽为0.04±0.010 ng/mL,餐后2小时C肽为0.09±0.020 ng/mL,就诊血糖为34.72±2.89 mmol/L,动脉血气pH为7.09±0.015。糖尿病酮症酸中毒734例(84.55%),发病前合并感染496例(56.75%),死亡4例(0.46%),GADA阳性78例,ICA阳性11例,IAA阳性13例;其中妊娠109例(死胎90例,82.57%)。结论我国F1DM是一种并非罕见的糖尿病亚型,其发病年龄轻,患者胰岛功能完全破坏,病情进展快,代谢紊乱严重,并发症多,预后凶险,临床医师需高度重视。

Objective To systematically review the prevalence,clinical characteristics,and prognosis of fulminant type 1 diabetes mellitus(F1DM)in China.Methods The CNKI,WanFang Data,CBM and PubMed databases were searched to collect Chinese F1MD case reports from January 1,2000 to March 30,2022.Data analysis was performed using Stata 16.0 software and RevMan 5.3 software.Results A total of 874 cases were included in 233 papers,involving 410 males(46.91%)and 464 females(53.09%).The age of onset was 29.32±1.09 years and the course of disease was 3.74±0.63 days.The BMI was 21.18±0.52 kg/m^(2),HbA1c was 6.58%±0.08%,the level of fasting C-peptide was 0.04±0.010 ng/mL,level of C-peptide 2 h after meal was 0.09±0.020 ng/mL,the level of blood glucose at the doctor’s office was 34.72±2.89 mmol/L,and the level of arterial blood gas pH was 7.09±0.015.Among them,734 patients had diabetic ketoacidosis(84.55%),496 patients had infection of the upper respiratory or digestive tract before onset(56.75%),4 patients died(0.46%),78 patients were GADA positive,11 patients were ICA positive,13 patients were IAA positive,and 109 were pregnant patients(90 fetal deaths,82.57%).Conclusion Chinese F1DM is a special but common subtype of diabetes.Its characteristics include a relatively young age of onset,devastating islet damage,and rapid progression,and it is often accompanied by severe metabolic disorders,complications,and grim prognosis.Clinicians should pay more attention to F1DM.