摘要
目的 研究初发1型糖尿病（T1DM）患儿发生糖尿病酮症酸中毒（DKA）的临床特点.通过初发相关影响因素探讨儿童糖尿病发生DKA的高危因素,以便早期识别.方法 对2009年1月至2012年12月中国医科大学附属盛京医院收治的200例初发T1DM患儿进行回顾性分析,按照有无DKA进行分组比较,观察2组在年龄、性别、医疗保险、体型、前驱感染史、糖尿病家族史、户口类型、月家庭收入、病程、C肽、糖化血红蛋白、血脂、甲状腺功能系列、糖尿病抗体等方面的差异.结果 200例初发T1 DM患儿中DKA组107例,非DKA组93例,DKA的发生率为53.5％.DKA组患儿中男39例（36.5％）,女68例,非DKA组男45例（48.4％）,女48例;DKA组患儿年龄16个月～13（6.53±3.55）岁,非DKA组年龄1～14（7.05±3.55）岁;DKA组患儿无医疗保险43例（40.2％）,非DKA组无医疗保险患儿28例（30.1％）;DKA组患儿中30例（28％）有糖尿病家族史,非DKA组中27例（29％）患儿有糖尿病家族史;DKA组病程为（30.24 ±76.50）d,非DKA组病程为（33.38 ±49.30） d;DKA组糖化血红蛋白为（12.38±2.66）％,非DKA组为（12.48±2.24）％,以上指标2组比较差异均无统计学意义（P均＞0.05）.DKA组患儿体型消瘦35例（32.7％）,体型正常66例（61.7％）,体型肥胖6例（5.6％）;非DKA组患儿消瘦9例（9.3％）,体型正常76例（78.6％）,体型肥胖8例（12.1％）.DKA组有前驱感染史33例（30.8％）,非DKA组有前驱感染史17例（18.3％）;在DKA组户口为农村77例（72.0％）,非DKA组户口为农村52例（55.9％）;DKA组C肽值为（0.25±0.22）μg/L,非DKA组C肽值为（0.36±0.21）μg/L,以上指标2组比较差异均有统计学意义（P均＜0.05）.结论 在初发T1DM患儿中体型消瘦、户籍类型为农村、C肽值低的患儿更易发生DKA.对具有以上特点的初发T1DM患儿应多予以关注.
Objective To summarize the clinical features of diabetic ketoacidosis （DKA） in children with newly diagnosed type 1 diabetes mellitus（T1DM）,and to explore the predictors of DKA by analyzing these factors in order to achieve early recognition.Methods In this retrospective study,200 children with newly-onset T1DM from January 2009 to December 2012 in Shengjing Hospital of China Medical University were chosen.These patients were divided into DKA group and non-DKA group.Clinical data including age,gender,health insurance,body shape,infection history,family history of diabetes,type of residence,income,duration of history,C peptide,glycosylated hemoglobin,blood lipids,thyroid tests,diabetes antibodies etc were collected.Results Among 200 cases of newly diagnosed T1DM,107 children had DKA,93 children had non-DKA,and the incidence of DKA was 53.5%.In the group of DKA,39 cases （36.5%） were male,68 cases were female,while in the group of non-DKA 45 cases （48.4%） were male,48 cases were female.In the group of DKA,children ranged in age from 16 months to 13 years old,and the average age was （6.53 ±3.55） years old.In the non-DKA group,children ranged in age from 1 to 14 years old,and the average age was （7.05 ± 3.55）years old.In the group of DKA,43 cases （40.2%） didn＇t have health insurance,while in the non-DKA group,28 cases （30.1%） didn＇t have medical insurance.In the DKA group,30 cases （28%） had a family history of diabetes,while in the non-DKA group,27 cases （29%） had a family history of diabetes.In the group of DKA,the duration was （30.24 ± 76.50）days,while in the group of non-DKA,the duration was （33.38 ± 49.30） days.The glycosylated hemoglobin in the DKA group was （12.38 ± 2.66）%,in the non-DKA group was （12.48 ± 2.24） %.There were no significantly differences of the above factors between the 2 groups （all P 〉 0.05）.In the group of DKA,35 cases（32.7%） were thin,66 cases（61.7%） were of normal size,and 6 cases（5.6%） were fat.In the group of non-DKA,9 cases（9.3%） were thin,76 cases （78.6%） were of normal size,and 8 cases（12.1%） were fat.In the group of DKA,33 cases （30.8%） had infection history,77 cases （72%） lived in rural areas,and the average of C peptide was （0.25 ± 0.22） μg/L.In the group of non-DKA,17 cases （18.3%） had infection history,52 cases（55.9%） in rural areas,and the average of C peptide was （0.36 ± 0.21） μg/L.There were significant differences of the above factors between the 2 groups （all P 〈 0.05）.Conclusions Children with newly diagnosed T1DM who is thin,rural resident,and has lower C peptide level is more susceptible to DKA.More attention should be paid to the children with newly diagnosed T1DM who have above characteristics.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2015年第8期585-588,共4页
Chinese Journal of Applied Clinical Pediatrics
作者简介
通信作者：辛颖，Email：xin．ying168@live．cn
