12例暴发性1型糖尿病临床特征分析

摘要

目的 分析12例暴发性1型糖尿病(FT1DM)的临床特征.方法 2012年1月至2017年2月于北京协和医院住院治疗的FT1DM患者12例,回顾性分析其临床资料及生化指标,并与日本FT1DM患者进行比较.结果 12例患者均于成年期发病,平均年龄(35.0±13.08)岁,男5例,7例患者出现前驱感染症状,有口渴、多饮症状者8例,所有患者均有消化道症状,且1周内出现DKA,发病时平均血糖(30.62±9.21) mmol/L,HbA1c水平5.0％～7.0％,胰岛β细胞功能几乎完全衰竭,胰岛相关自身抗体(GADAb、ICA、IA2)均阴性,70％以上患者伴胰酶升高.与日本FT1DM患者比较,12例患者发病时血糖[(31±9)vs(44±20) mmol/L]、高血糖症状发生率(66.67％vs93.7％)及脂肪酶升高比例(42.86％vs84.75％)较低,血pH值[(7.24±0.12)vs(7.12±0.12),P＜0.05]较高.结论 FT1DM发病急骤,病情危重,需长期依赖胰岛素治疗,应引起重视.%Objective To analyze the clinical characteristics of 12 patients with fulminant type 1 diabetes mellitus (FT1DM).Methods A total of 12 hospitalized patients with FT1DM were enrolled in this study from Peking Union Medical College Hospital between January 2012 and February 2017.Clinical materials and biochemical indexes were collected and compared with FT1DM in Japan.Results All the 12 patients presented as adult onset and the average age was (35.0± 13.08) years old.Five patients were male.Seven patients had flu-like symptoms,and eight patients had thirst and polydipsia.All patients had abdominal symptoms and presented with ketoacidosis within one week.The average plasma glucose level was (30.62±9.21) mmol/L and the range of HbA1 c level was 5.0％7.0％.Islet-related autoantibodies (GAD,ICA,IA2) were negative and pancreatic beta cells were rapidly destroyed.More than 70 ％ patients had elevated serum pancreatic enzyme levels.Compared with FT1DM in Japanese patients,our patients tended to have lower plasma glucose[(31 ± 9) vs (44 ± 20) mmol/L],lower percent of diabetes symptoms (66.67％ vs 93.7％)and abnormal serum lipase values(42.86％ vs 84.75％),and higher arterial pH [(7.24±0.12) vs (7.12±0.12)](P＜0.05).Conclusion FT1DM was remarkably abrupt onset and lifelong injection of exogenous insulin is inevitable.Physicians should sharpen their awareness of FT1DM.