1型糖尿病患者中Mauriac综合征的筛查及临床、生化特点分析

Screening for Mauriac syndrome in patients with type 1 diabetes and analyzing its clinical and biochemical characteristics

目的探讨1型糖尿病(type 1 diabetes mellitus,T1DM)患者中Mauriac综合征的患病情况及其临床、生化特点。方法本研究为病例对照研究,选取2012年1月至2020年12月于新疆维吾尔自治区人民医院内分泌与代谢病科住院的T1DM患者为病例组,按照年龄和性别以1∶4匹配转氨酶正常的T1DM患者作为对照组。收集研究对象的性别、年龄,以及腹痛、腹胀、呕吐、身材矮小、糖尿病酮症酸中毒(DKA)复发史等情况,测定其总胆固醇(TC)、甘油三酯(TG)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸、乳酸脱氢酶、糖化血红蛋白(HbA1c)等,检查患者是否有肝肿大。采用t检验、Mann‐WhitneyU检验、连续性校正的χ2检验或Fisher精确概率法检验比较组间计量资料和计数资料的差异。结果共纳入T1DM患者286例,最终被诊断为Mauriac综合征的有12例。其中,年龄<18岁5例,年龄≥18岁的7例;腹痛5例,既往有DKA复发史6例,腹胀3例,身材矮小2例,呕吐3例,影像学提示肝肿大9例。与对照组相比,病例组中患者的腹胀、肝肿大和DKA复发人数均更多,HbA1c、TC、TG、ALT、AST、乳酸、乳酸脱氢酶均更高,差异均具有统计学意义(Ρ<0.05)。结论对于血糖控制欠佳且存在转氨酶升高和(或)肝肿大的T1DM患者,若同时伴有TC、TG、乳酸及乳酸脱氢酶水平的升高,应警惕发生Mauriac综合征的可能。

Objective To investigate the prevalence,and clinical and biochemical characteristics of Mauriac syndrome in patients with type 1 diabetes mellitus(T1DM).Methods This study was a case-control study.The patients with T1DM who met the inclusion and exclusion criteria in the Department of Endocrinology and Metabolic Diseases,Xinjiang Uygur Autonomous Region People′s Hospital from January 2012 to December 2020 were selected as the case group,and T1DM patients with normal transaminases were matched 1∶4 according to age and sex as the control group.The gender,age,and the number of subjects with abdominal pain,abdominal distension,vomiting,short stature,and history of recurrence of diabetic ketoacidosis(DKA)were collected,and their total cholesterol(TC)and triglyceride(TG)were determined.The glutamic pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),lactate,lactate dehydrogenase,glycated hemoglobin A1c(HbA1c),etc,were determined as well.The patient was examined for hepatomegaly at the same time.The t test,Mann-Whitney U test,χ2 test or Fisher test were used to compare the differences of measurement data and enumeration data between groups.Results A total of 286 T1DM patients were included,of which 12 were eventually diagnosed with Mauriac syndrome.Among them,there were 5 cases aged<18 years and 7 cases aged≥18 years;5 cases with abdominal pain,6 cases with previous history of DKA recurrence,3 cases with abdominal distention,2 cases with short stature,3 cases with vomiting,and 9 cases with imaging suggestive of hepatomegaly.Compared with the control group,the patients in the case group had more abdominal distension,hepatomegaly and recurrence of DKA,and higher HbA1c,TC,TG,ALT,AST,lactate and lactate dehydrogenase(Ρ<0.05).Conclusions In T1DM patients with poor blood sugar control and elevated transaminase and/or hepatomegaly,the possibility of Mauriac syndrome should be alerted if the patients accompanied by elevated levels of TC,TG,lactate and lactate dehydrogenase.