2011—2021年基于文献的中国特殊类型糖尿病分布特征分析

Clinical Original ArticleDistribution characteristics of special types of diabetes mellitus in Chinese population: A literature-based analysis from 2011 to 2021

目的分析中国特殊类型糖尿病的分布特点,以期为特殊糖尿病的诊治提供理论依据。方法系统检索PubMed、中国知网和万方数据库中2011—2021年有关中国特殊类型糖尿病病例报道或临床研究。由2名研究者依据纳排标准进行文献筛选后,提取纳入文献的疾病名称和对应病例数进行统计,进而分析3大亚类特殊类型糖尿病的病因构成和疾病特征。结果共纳入613篇文献(7377例特殊类型糖尿病患者),按病因学分类粗分为8个亚类特殊类型糖尿病进行疾病构成比分析,结果由高及低依次为胰岛β细胞功能单基因缺陷、胰源性糖尿病、药物或化学品所致糖尿病、内分泌疾病、胰岛素作用单基因缺陷、其他与糖尿病相关的遗传综合征、感染、不常见的免疫介导性糖尿病。重点关注的3个亚类特殊类型糖尿病的疾病构成分别是:胰岛β细胞功能单基因缺陷(占50.21%)、胰源性糖尿病(占35.65%)和胰岛素作用单基因缺陷(占1.56%)。各亚类特殊类型糖尿病病因构成分析结果显示新生儿糖尿病(neonatal diabetes mellitus,NDM)1749例(23.71%)和青少年发病的成人型糖尿病(maturity onset diabetes in young,MODY)1554例(21.07%)占比最多。对MODY患者各亚型进行构成分析,占比排在前三位的是MODY2(50.89%)、MODY3(16.03%)、MODYX(8.91%)。此外,以MODY为例进行新发突变(de novo mutations,DNMs)和新突变位点统计,结果显示携带新发突变的MODY患者31例(1.99%),携带新突变位点的MODY患者339例(21.81%)。结论文献报道的中国特殊类型糖尿病患者中NDM和MODY占比最高。而在MODY患者中,MODY2患者的比例最高。此外,携带新发突变和(或)新突变位点的糖尿病患者应予重视。

Objective To analyze the distribution characteristics of special types of diabetes in China,in order to provide a theoretical basis for the diagnosis and treatment of special types of diabetes.Methods Pubmed,CNKI,and WanFang Data were searched for the case reports and clinical studies of special types of diabetes in China from 2011 to 2021.After independent literature screening by 2 researchers according to the inclusion and exclusion criteria,diseases and the number of corresponding cases included were extracted for statistics.The etiological composition and disease characteristics of three subtypes of special type diabetes were analyzed.Results A total of 613 articles(7377 patients)were included and roughly divided into eight subtypes of special type diabetes according to etiological classification for disease composition analysis.The results by ratio in descending order were as follows:mono-genetic gene defects in isletβ-cell function,pancreatogenic diabetes,diabetes induced by drugs or chemicals,endocrine disease,mono-genetic gene defects in insulin action,other genetic syndromes associated with diabetes,infection,and uncommon immune-mediated diabetes.The disease composition of the three subtypes of special types of diabetes that we focused on were mono-genetic gene defects in isletβ-cell function(50.21%),pancreatogenic diabetes(35.65%),and mono-genetic gene defects in insulin action(1.56%).The composition analysis of the special types of diabetes in each subtype showed that neonatal diabetes mellitus(NDM,n=1749,23.71%)and maturity onset diabetes in young(MODY,n=1554,21.07%)accounted for the largest proportions.According to the composition analysis of each subtype of MODY patients,the top three subtypes were MODY2(50.89%),MODY3(16.03%),and MODYX(8.91%).In addition,taking MODY as an example,patients with de novo mutations(DNMs)and(or)new mutation sites were summarized and analyzed.The results revealed 31 MODY patients with DNMs(1.99%)and 339 MODY patients with new mutation sites(21.81%).Conclusions According to the literature analysis,NDM and MODY represent the largest proportion of patients with special type diabetes in China.MODY2 patients make up the largest proportion of MODY patients.In addition,diabetic patients carrying DNMs and(or)new mutation sites should be taken seriously.