中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2011年
6期
468-471
,共4页
范元硕%时立新%罗建华%于瑞萍%刘波%龙本丹
範元碩%時立新%囉建華%于瑞萍%劉波%龍本丹
범원석%시립신%라건화%우서평%류파%룡본단
糖尿病%酮症%分型
糖尿病%酮癥%分型
당뇨병%동증%분형
Diabetes mellitus%Ketosis%Classification
目的 探讨新诊断酮症起病糖尿病的临床特征及初步分型.方法 根据胰岛白身抗体是否阳性(A+或A-)和β细胞功能是否保留(β+或β-),将2008年7月至2009年8月于贵州省人民医院内分泌科收治的86例新诊断酮症起病糖尿病患者分为4组:A+β -组、A+β+组、A-β-组和A-β+组.比较各组性别比、年龄、伴代谢综合征、体质指数、随机血糖、糖化血红蛋白、血β羟丁酸、C肽等临床资料.采用方差分析对研究数据进行统计分析.结果 A+β-、A+β+、A-β-、A-β+组分别为15例(17.4%,男9例,女6例)、5例(5.8%,男3例,女2例)、27例(31.4%,男20例,女7例)和39例(45.4%,男26例,女13例).A+β-组发病年龄、体质指数、腰围及二氧化碳结合力水平均明显低于其他3组[4组发病年龄分别为(24±12)、(44±13)、(43±13)和(54±17)岁;体质指数分别为(18±3)、(22±3)、(22±3)和(24±4) kg/m2;腰围分别为(69±12)、(82±5)、(81±9)和(86±10)cm;二氧化碳结合力分别为(12±7)、(20±4)、(19±7)和(21±4)mmol/L;均P<0.05],随机血糖及血β羟丁酸水平均明显高于其他3组[4组随机血糖分别为(32±9)、(19±3)、(25±9)和( 23±6)mmol/L;血β羟丁酸分别为4.80(1.74 ~ 14.03)、0.79(0.41~3.37)、1.34(0.33 ~ 15.75)和0.80(0.31 ~8.27)mmol/L;均P<0.05].A-β-组发病年龄及体质指数均明显低于A-β+组(均P<0.05).A-β+组伴代谢综合征比例(48.7%)明显高于A+β-组(6.7%)及A-β-组(22.2%)(均P<0.05).A+β-组和A-β-组空腹C肽、餐后2hC肽水平均明显低于A+β+组和A-β+组[空腹C肽分别为0.25(0.18 ~0.39)、0.30(0.03 ~0.63)、0.87(0.62 ~1.18)和1.16(0.75 ~3.46) μg/L,均P<0.01;餐后2hC肽分别为0.56(0.21 ~2.02)、1.00(0.25 ~1.94)、3.45(1.73 ~3.84)和2.28(1.14~13.79)μg/L,均P<O.01].结论 A+β-、A+β+、A-β-和A-β+组可基本对应于经典的自身免疫性1型糖尿病、成人隐匿性自身免疫性糖尿病、特发性1型糖尿病和2型糖尿病.
目的 探討新診斷酮癥起病糖尿病的臨床特徵及初步分型.方法 根據胰島白身抗體是否暘性(A+或A-)和β細胞功能是否保留(β+或β-),將2008年7月至2009年8月于貴州省人民醫院內分泌科收治的86例新診斷酮癥起病糖尿病患者分為4組:A+β -組、A+β+組、A-β-組和A-β+組.比較各組性彆比、年齡、伴代謝綜閤徵、體質指數、隨機血糖、糖化血紅蛋白、血β羥丁痠、C肽等臨床資料.採用方差分析對研究數據進行統計分析.結果 A+β-、A+β+、A-β-、A-β+組分彆為15例(17.4%,男9例,女6例)、5例(5.8%,男3例,女2例)、27例(31.4%,男20例,女7例)和39例(45.4%,男26例,女13例).A+β-組髮病年齡、體質指數、腰圍及二氧化碳結閤力水平均明顯低于其他3組[4組髮病年齡分彆為(24±12)、(44±13)、(43±13)和(54±17)歲;體質指數分彆為(18±3)、(22±3)、(22±3)和(24±4) kg/m2;腰圍分彆為(69±12)、(82±5)、(81±9)和(86±10)cm;二氧化碳結閤力分彆為(12±7)、(20±4)、(19±7)和(21±4)mmol/L;均P<0.05],隨機血糖及血β羥丁痠水平均明顯高于其他3組[4組隨機血糖分彆為(32±9)、(19±3)、(25±9)和( 23±6)mmol/L;血β羥丁痠分彆為4.80(1.74 ~ 14.03)、0.79(0.41~3.37)、1.34(0.33 ~ 15.75)和0.80(0.31 ~8.27)mmol/L;均P<0.05].A-β-組髮病年齡及體質指數均明顯低于A-β+組(均P<0.05).A-β+組伴代謝綜閤徵比例(48.7%)明顯高于A+β-組(6.7%)及A-β-組(22.2%)(均P<0.05).A+β-組和A-β-組空腹C肽、餐後2hC肽水平均明顯低于A+β+組和A-β+組[空腹C肽分彆為0.25(0.18 ~0.39)、0.30(0.03 ~0.63)、0.87(0.62 ~1.18)和1.16(0.75 ~3.46) μg/L,均P<0.01;餐後2hC肽分彆為0.56(0.21 ~2.02)、1.00(0.25 ~1.94)、3.45(1.73 ~3.84)和2.28(1.14~13.79)μg/L,均P<O.01].結論 A+β-、A+β+、A-β-和A-β+組可基本對應于經典的自身免疫性1型糖尿病、成人隱匿性自身免疫性糖尿病、特髮性1型糖尿病和2型糖尿病.
목적 탐토신진단동증기병당뇨병적림상특정급초보분형.방법 근거이도백신항체시부양성(A+혹A-)화β세포공능시부보류(β+혹β-),장2008년7월지2009년8월우귀주성인민의원내분비과수치적86례신진단동증기병당뇨병환자분위4조:A+β -조、A+β+조、A-β-조화A-β+조.비교각조성별비、년령、반대사종합정、체질지수、수궤혈당、당화혈홍단백、혈β간정산、C태등림상자료.채용방차분석대연구수거진행통계분석.결과 A+β-、A+β+、A-β-、A-β+조분별위15례(17.4%,남9례,녀6례)、5례(5.8%,남3례,녀2례)、27례(31.4%,남20례,녀7례)화39례(45.4%,남26례,녀13례).A+β-조발병년령、체질지수、요위급이양화탄결합력수평균명현저우기타3조[4조발병년령분별위(24±12)、(44±13)、(43±13)화(54±17)세;체질지수분별위(18±3)、(22±3)、(22±3)화(24±4) kg/m2;요위분별위(69±12)、(82±5)、(81±9)화(86±10)cm;이양화탄결합력분별위(12±7)、(20±4)、(19±7)화(21±4)mmol/L;균P<0.05],수궤혈당급혈β간정산수평균명현고우기타3조[4조수궤혈당분별위(32±9)、(19±3)、(25±9)화( 23±6)mmol/L;혈β간정산분별위4.80(1.74 ~ 14.03)、0.79(0.41~3.37)、1.34(0.33 ~ 15.75)화0.80(0.31 ~8.27)mmol/L;균P<0.05].A-β-조발병년령급체질지수균명현저우A-β+조(균P<0.05).A-β+조반대사종합정비례(48.7%)명현고우A+β-조(6.7%)급A-β-조(22.2%)(균P<0.05).A+β-조화A-β-조공복C태、찬후2hC태수평균명현저우A+β+조화A-β+조[공복C태분별위0.25(0.18 ~0.39)、0.30(0.03 ~0.63)、0.87(0.62 ~1.18)화1.16(0.75 ~3.46) μg/L,균P<0.01;찬후2hC태분별위0.56(0.21 ~2.02)、1.00(0.25 ~1.94)、3.45(1.73 ~3.84)화2.28(1.14~13.79)μg/L,균P<O.01].결론 A+β-、A+β+、A-β-화A-β+조가기본대응우경전적자신면역성1형당뇨병、성인은닉성자신면역성당뇨병、특발성1형당뇨병화2형당뇨병.
Objective To investigate the clinical characteristics and primary classification of newly diagnosed ketosis-onset diabetes.Methods Based on the presence or absence of islet autoantibodies (A + or A - ) and of β - cell functional reserve ( β + or β - ),86 patients with newly diagnosed ketosis-onset diabetes from July 2008 to August 2009 were divided into 4 groups:A + β -,A + β +,A - β - and A - β + group.Clinical characteristics,including gender,age,presence of metabolic syndrome,body mass index,random blood glucose,glycosylated hemoglobin,β hydroxybutyric acid and C-peptide levels,et al,were compared among the 4 groups.Analysis of variance was used for statistic analysis.Results Therewere 15 cases in A + β - group( 17.4%,male 9,female 6),5 cases in group A + β + (5.8%,male 3,female 2),27 cases in group A - β - (31.4%,male 20,female 7 ) and 39 cases in group A - β + (45.4%,male 26,female 13),respectively.Group A + β - had obviously lower age,body mass index,waist circumference and carbon dioxide combining power than those in group A + β +,A - β - and A - β +( age:( 24 ± 12 ) vs ( 44 ± 13 ),( 43 ± 13 ) and ( 54 t 17 ) years,respectively,all P < 0.05 ; body massindex:( 18 ± 3 ) vs ( 22 ± 3 ),( 22 ± 3 ) and ( 24 ± 4 ) kg/m2,respectively,all P < 0.05 ; waist circumference:(69 ± 12) vs (82 ±5),(81 ±9) and (86 ± 10) cm,respectively,all P<0.05; carbon dioxide combining power:(12±7) vs (20±4),(19 ±7) and (21±4) mmol/L,respectively,all P< 0.05 ).Random blood glucose and β hydroxybutyric acid levels in group A + β - were obviously higher than those in group A + β +,A - β - and A - β + ( random blood glucose:( 32 ± 9) vs ( 19 ± 3 ),( 25 ± 9 ) and ( 23 ± 6) mmol/L,respectively,all P < 0.05 ; 3 hydroxybutyric acid:4.80 ( 1.74 - 14.03 ) vs 0.79 ( 0.41-3.37 ),1.34 ( 0.33-15.75 ) and 0.80 ( 0.31-8.27 ) mmol/L,respectively,all P < 0.05 ).Group A - β - had obviously lower age and body mass index than those in group A - β + ( all P < 0.05 ).Group A - β + had obviously higher proportion ( 48.7% ) of metabolic syndrome than those in group A + β - (6.7% ) and group A - β - ( 22.2% ) ( both P < 0.05 ).The levels of fasting C-peptide,postprandial C-peptide in A + β - and A - β - group were obviously lower than those in group A + β + and A - β + ( fasting C-peptide:0.25 (0.18-0.39),0.30(0.03-0.63),0.87(0.62-1.18) and 1.16(0.75-3.46) μg/L,respectively,all P < 0.01 ; postprandial C-peptide:0.56 (0.21-2.02 ),1.00 (0.25-1.94),3.45 ( 1.73-3.84 ) and 2.28 ( 1.14-13.79 ) μg/L,respectively,all P <0.01 ).Conclusions The patients in the A + β -,A +β +,A - β - and A - β + groups may be assigned to autoimmune type 1 diabetes mellituso latent autoimmune diabetes in adults,idiopathic type 1 diabetes mellitus and type 2 diabetes mellitus,respectively.