中国暴发性1型糖尿病患者临床特点分析

发布时间：2018-03-31 13:29

本文选题：暴发性　切入点：1型糖尿病临床特点　出处：《广西医科大学》2015年硕士论文

【摘要】：目的：探讨中国暴发性1型糖尿病患者的临床特点。方法：回顾性分析广西医科大学第九附属医院2003年1月至2014年12月期间以酮症或酮症酸中毒起病患者,根据日本Hanafusa等提出的暴发性1型糖尿病诊断标准[1],有7例F1D患者,分析我院7例暴发性1型糖尿病患者临床特点。同时利用知网、万方、维普三大中文数据库,通过输入“暴发性1型糖尿病”关键词查阅2005年至2014年我国关于F1D的文献报道。去除重复、综述、会议及仅有摘要的文章,剩余111篇文献。采用日本Hanafusa等[1]提出的暴发性1型糖尿病诊断标准,从111篇病例报道中纳入45例F1D患者,联合我院7例F1D患者,分析该52例F1D患者的临床特征,并与日本、韩国暴发性1型糖尿病患者的临床特点进行比较。结果：1、本院收治的7例暴发性1型糖尿病患者中男性5例,女性2例。均以酮症酸中毒起病,病程仅1-3天,起病时血糖均大于16.Ommol/L。胰岛功能极差,空腹血浆C肽0.1 nmol/L(0.3 ng/ml),且刺激后(餐后或胰高血糖素注射后)血浆C肽0.17 nmol/L(0.5 ng/ml)。起病时均出现了电解质代谢紊乱及肾功能衰竭,一些患者还出现了肝酶、肌酶、淀粉酶等酶学异常。经治疗后均好转出院,出院后均需胰岛素控制血糖,胰岛素用量为16-49U/d。2、①中国暴发性1型糖尿病患者平均发病年龄为32.2±12.6岁,18岁以上患者约占总数的96%,而且18-30岁的病例数最多,约占总数的52%。②男、女患者临床特点比较,结果显示男性患者起病时血钾水平高于女性患者,两组患者发病年龄、病程、起病时血糖、动脉血PH、血钠及HbAlc水平比较无统计学差异。③妊娠相关性暴发性1型糖尿病患者与非妊娠相关性暴发性1型糖尿病患者临床特点比较,两组患者起病时的血糖、病程、HbAlc水平、动脉血pH、血钠、血钾差异无显著统计学意义。④和日本患者相比,我国暴发性1型糖尿病患者的发病年龄更低、病程更短、发病时血糖较低；电解质代谢紊乱更严重,表现为高血钾、低血钠。⑤与韩国暴发性1型糖尿病患者相比,我国暴发性1型糖尿病患者发病年龄更低,起病时血钾更高。结论：①暴发性1型糖尿病在我国并非罕见,且患者多以成年起病。②妊娠相关性暴发性1型糖尿病患者与非妊娠相关性暴发性1型糖尿病患者临床特点相似。③中国暴发性1型糖尿病患者发病年龄较日本、韩国患者小,发病时血钾更高。
[Abstract]:Objective: to investigate the clinical characteristics of patients with fulminant type 1 diabetes mellitus in China. Methods: the patients with ketoacidosis or ketoacidosis from January 2003 to December 2014 in the Ninth affiliated Hospital of Guangxi Medical University were analyzed retrospectively. According to the diagnostic criteria of fulminant type 1 diabetes put forward by Hanafusa et al in Japan, there were 7 cases of F1D patients. The clinical characteristics of 7 cases of fulminant type 1 diabetes in our hospital were analyzed. The key words of "fulminant type 1 diabetes" were used to review the literature on F1D in China from 2005 to 2014. According to the diagnostic criteria proposed by Hanafusa et al. [1], 45 patients with F1D and 7 patients with F1D in our hospital were included in this study. The clinical features of 52 patients with F1D were analyzed and compared with those in Japan. Results the clinical characteristics of 7 cases of fulminant type 1 diabetes mellitus in South Korea were compared. Results among 7 cases of type 1 diabetes treated in our hospital, 5 cases were male and 2 cases were female. All of them were caused by ketoacidosis and the course of disease was only 1-3 days. The plasma glucose was higher than 16.Ommol / L. the islet function was extremely poor, the fasting plasma C-peptide was 0.1 nmol/L(0.3 / ml / ml, and after stimulation (postprandial or glucagon injection), the plasma C-peptide 0.17 nmol/L(0.5 / ml 路ml. Some patients also showed abnormal enzymes such as liver enzymes, muscle enzymes, amylase, and so on. After treatment, they were all better and discharged from hospital, all of whom needed insulin to control their blood sugar after discharge. The average age of onset of fulminant type 1 diabetes in China was 32.2 卤12.6 years old or over 18 years old, and the number of patients aged 18-30 years was the most, accounting for 522.2% of the total number of cases. The clinical characteristics of female patients were compared. The results showed that the serum potassium level of male patients was higher than that of female patients. There was no significant difference in blood PH, serum sodium and HbAlc levels. 3 the clinical characteristics of patients with pregnancy-associated fulminant type 1 diabetes mellitus and those with non-pregnancy associated type 1 diabetes mellitus were compared. The blood glucose, course of disease and HbAlc level were compared between the two groups. There was no significant difference in pH, sodium and potassium between arterial blood and Japanese patients. Compared with Japanese patients, the onset age of fulminant type 1 diabetes in China was lower, the course of disease was shorter, the blood glucose was lower and the electrolyte metabolism disorder was more serious. Compared with Korean patients with fulminant type 1 diabetes, the patients with fulminant type 1 diabetes in China have lower onset age and higher serum potassium at the onset of the disease. Conclusion it is not uncommon in China to have 1 type 1 diabetes mellitus. The clinical characteristics of patients with type 1 diabetes associated with pregnancy and non-pregnancy associated type 1 diabetes were similar. 3 the age of onset of type 1 diabetes in China was lower than that in Japan, and that in Korea was younger than that in South Korea. The blood potassium level is higher at the time of onset.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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