以酮症酸中毒起病的暴发性1型糖尿病的调查及实验室指标分析

发布时间：2018-04-27 18:23

  本文选题：暴发性1型糖尿病 + 实验室指标　； 参考：《广西医科大学》2016年硕士论文

【摘要】：目的：调查新诊断标准下以DKA起病的暴发性1型糖尿病的患病状况并探讨其实验室指标特点。方法：1.回顾性分析广西医科大学第九附属医院2003年1月至2013年12月收治的238例糖尿病酮症酸中毒住院患者(含重复住院患者)情况,按2012年日本Imagawa提出的诊断标准,筛选出酮症酸中毒起病的暴发性1型糖尿病(Fulminant Type 1 Diabetes Mellitus, FT1DM)患者；并结合182例发表在国内文献上DKA起病的FTIDM病例,分析DKA起病的FTIDM的流行病学特点。2.本院7例DKA起病的FTIDM患者,结合国内报道的18例患者,对DKA起病的FTIDM患者的实验室指标进行分析。3.从上述238例DKA患者中筛选出DKA起病的T2DM为A组(34例),DKA起病的T1DM(非暴发性T1DM)为B组(34例),上述DKA起病的FT1DM为C组(25例),比较三组间实验室指标。分别从A组和B组中筛选出病程在三月以内的病例为A1组(33例)和B1组(32例),与C组的实验室指标进行比较分析。再分别从A1组和B1组中筛选出病程在一周以内的病例为A2组(22例)和B2组(19例),与C组的实验室指标进行比较分析。结果：①238例糖尿病酮症酸中毒患者中,T1DM99例(其中FTIDM 7例),95例患者以酮症酸中毒为其糖尿病就诊的初发表现(其中T1DM47例)。7例FT1DM占连续住院DKA病例的2.9%(7/238),占TlDM所致DKA的7.1%(7/99)；占DKA起病的新诊断糖尿病病例的7.4%(7/95),占DKA起病T1DM病例的14.9%(7/47)。截止至2013年,国内报道189例DKA起病的FT1DM中,南方146例,北方43例,年龄最大为71岁,年龄最小为2岁。②25例DKA起病的FT1DM患者：男性10例,女性15例；南方19例,北方6例；妊娠相关8例；≤30岁11例,30岁14例。男性和女性、南方和北方、妊娠相关和非妊娠相关、≤30岁和30岁患者的血糖、HbAlc、血钠、血钾、血pH值比较差异均无统计学意义。③C组起病时的血糖、血钾显著高于A组、B组、A1组、B1组、A2组、B2组,而HbAl c则显著低于A组、B组、A1组、B1组、A2组、B2组；C组起病时的血钠、血pH值显著低于A组、A1组,B组的血钠显著低于A组,其余的比较没有统计学意义。结论：1以DKA起病的FT1DM发病为散发,在DKA起病糖尿病患者中占有一定比例。2.以DKA起病的FTIDM患者起病时HbA1c小于8.7%的同时,呈现高血糖、低血钠、高血钾、低pH值的特点。3.DKA起病的FTIDM患者起病时血糖、血钾比DKA起病的非暴发性TIDM、DKA起病的T2DM的高,而其HbA1c比DKA起病的非暴发性TIDM、DKA起病的T2DM的低,病程会对比较的结果产生影响。
[Abstract]:Objective: to investigate the prevalence of fulminant type 1 diabetes mellitus (TDM) with DKA onset under the new diagnostic criteria and to explore its laboratory characteristics. Method 1: 1. A retrospective analysis of 238 cases of diabetic ketoacidosis (including repeated inpatients) admitted from January 2003 to December 2013 in the Ninth affiliated Hospital of Guangxi Medical University was carried out. Patients with fulminant Type 1 Diabetes Mellitus (FT1DM) with ketoacidosis were selected, and the epidemiological characteristics of FTIDM from DKA were analyzed. The laboratory indexes of 7 FTIDM patients with DKA onset and 18 reported FTIDM patients with DKA were analyzed. From the above 238 cases of DKA, 34 cases of T2DM with DKA onset were selected as group A and 34 cases with non-fulminant T1DM as group B, and 25 cases with FT1DM of group C with the above mentioned DKA. The laboratory indexes were compared among the three groups. 33 cases of group A1 and 32 cases of group B1 were selected from group A and group B within three months. The laboratory indexes of group A and group C were compared and analyzed. 22 cases in group A 2 and 19 cases in group B 2 were selected from group A1 and group B1, respectively. The laboratory indexes of group A 1 and group B 1 were compared with those of group C. Results among 1238 cases of diabetic ketoacidosis, 99 cases of T1DM (including 7 cases of FTIDM and 95 cases of ketoacidosis) were treated with ketoacidosis as the initial manifestation of diabetes mellitus (among them, T1DM47 cases accounted for 2.7% of DKA cases, accounting for 2.9% of TlDM cases, accounting for DKA caused by TlDM). The ratio of 7.1% to 7 / 99%; 7 / 95% of the newly diagnosed diabetes cases in DKA, and 14. 9% of 7 / 47% of the cases of DKA onset T1DM. Up to 2013, there were 146 cases of FT1DM in the south, 43 cases in the north, and the maximum age was 71 years old, and the youngest was 2 years old. 225 cases of FT1DM patients with onset of DKA were 10 males, 15 females, 19 patients from the south, 6 patients from the north, and 14 cases from the south, 6 cases from the north, 10 cases from the male to 15 cases from the female, 19 cases from the south and 6 cases from the north. Pregnancy related in 8 cases, 鈮，

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