中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2013年
8期
477-480
,共4页
李豫川%曹冰燕%巩纯秀%梁学军%王琳琳
李豫川%曹冰燕%鞏純秀%樑學軍%王琳琳
리예천%조빙연%공순수%량학군%왕림림
糖尿病%儿童,住院%患病率
糖尿病%兒童,住院%患病率
당뇨병%인동,주원%환병솔
Diabetes mellitus%Child,hospitalized%Prevalence
目的 以住院患儿为研究对象,调查儿童继发性糖尿病的患病率及相关因素分析.方法 回顾性评估2002年1月至2010年12月北京儿童医院18岁以下住院患儿中继发性糖尿病的患病率.根据与继发性糖尿病组的原发病、年龄、性别相匹配原则,按1:4的比例设置对照组,使用logistic回归分析相关危险因素.结果 9657例18岁以下住院患儿中33例(0.34％)(年龄7.1～16.4岁,男孩15例,女孩18例)患上继发性糖尿病.其中淋巴瘤和急性淋巴细胞性白血病干细胞移植术后的继发性糖尿病患病率最高,分别是4.17％和3.70％,其次为多发性硬化症1.67％；系统性红斑狼疮、皮肌炎、急性淋巴细胞性白血病(未行干细胞移植者)、组织细胞增多症、特发性血小板减少性紫癜、肾病综合征的继发性糖尿病的患病率均低于1.0％.男童继发性糖尿病发病率低于女童(0.24％比0.53％,x2=4.79,P＜0.05).18例血液系统恶性肿瘤患儿确诊为继发性糖尿病,其中12例在接受L-天冬氨酰胺酶治疗6d内发生了继发性糖尿病；2例未使用L-天冬氨酰胺酶的患儿分别在化疗第45天和210天时确诊；其余4例在造血干细胞移植术后60 ～ 450 d时发生继发性糖尿病.15例以糖皮质激素为主要治疗的患儿在治疗后2 d～4.7年时被确诊为糖尿病.这些患儿均无糖尿病的典型症状,无合并糖尿病酮症酸中毒者.Logistic回归分析显示,年龄较大者发生继发性糖尿病的风险是较小者的1.24倍[95％可信区间(CI):1.08 ～ 1.42,P ＜0.05],肥胖儿是正常体重儿的5.08倍(95％ CI:2.02 ～ 12.78,P＜0.05).结论 本研究显示国内儿童继发性糖尿病患病率较国外低,并因性别年龄段和原发病种的不同而不同；继发性糖尿病症状不典型,易漏诊,疾病全程需要监测血糖.
目的 以住院患兒為研究對象,調查兒童繼髮性糖尿病的患病率及相關因素分析.方法 迴顧性評估2002年1月至2010年12月北京兒童醫院18歲以下住院患兒中繼髮性糖尿病的患病率.根據與繼髮性糖尿病組的原髮病、年齡、性彆相匹配原則,按1:4的比例設置對照組,使用logistic迴歸分析相關危險因素.結果 9657例18歲以下住院患兒中33例(0.34％)(年齡7.1～16.4歲,男孩15例,女孩18例)患上繼髮性糖尿病.其中淋巴瘤和急性淋巴細胞性白血病榦細胞移植術後的繼髮性糖尿病患病率最高,分彆是4.17％和3.70％,其次為多髮性硬化癥1.67％；繫統性紅斑狼瘡、皮肌炎、急性淋巴細胞性白血病(未行榦細胞移植者)、組織細胞增多癥、特髮性血小闆減少性紫癜、腎病綜閤徵的繼髮性糖尿病的患病率均低于1.0％.男童繼髮性糖尿病髮病率低于女童(0.24％比0.53％,x2=4.79,P＜0.05).18例血液繫統噁性腫瘤患兒確診為繼髮性糖尿病,其中12例在接受L-天鼕氨酰胺酶治療6d內髮生瞭繼髮性糖尿病；2例未使用L-天鼕氨酰胺酶的患兒分彆在化療第45天和210天時確診；其餘4例在造血榦細胞移植術後60 ～ 450 d時髮生繼髮性糖尿病.15例以糖皮質激素為主要治療的患兒在治療後2 d～4.7年時被確診為糖尿病.這些患兒均無糖尿病的典型癥狀,無閤併糖尿病酮癥痠中毒者.Logistic迴歸分析顯示,年齡較大者髮生繼髮性糖尿病的風險是較小者的1.24倍[95％可信區間(CI):1.08 ～ 1.42,P ＜0.05],肥胖兒是正常體重兒的5.08倍(95％ CI:2.02 ～ 12.78,P＜0.05).結論 本研究顯示國內兒童繼髮性糖尿病患病率較國外低,併因性彆年齡段和原髮病種的不同而不同；繼髮性糖尿病癥狀不典型,易漏診,疾病全程需要鑑測血糖.
목적 이주원환인위연구대상,조사인동계발성당뇨병적환병솔급상관인소분석.방법 회고성평고2002년1월지2010년12월북경인동의원18세이하주원환인중계발성당뇨병적환병솔.근거여계발성당뇨병조적원발병、년령、성별상필배원칙,안1:4적비례설치대조조,사용logistic회귀분석상관위험인소.결과 9657례18세이하주원환인중33례(0.34％)(년령7.1～16.4세,남해15례,녀해18례)환상계발성당뇨병.기중림파류화급성림파세포성백혈병간세포이식술후적계발성당뇨병환병솔최고,분별시4.17％화3.70％,기차위다발성경화증1.67％；계통성홍반랑창、피기염、급성림파세포성백혈병(미행간세포이식자)、조직세포증다증、특발성혈소판감소성자전、신병종합정적계발성당뇨병적환병솔균저우1.0％.남동계발성당뇨병발병솔저우녀동(0.24％비0.53％,x2=4.79,P＜0.05).18례혈액계통악성종류환인학진위계발성당뇨병,기중12례재접수L-천동안선알매치료6d내발생료계발성당뇨병；2례미사용L-천동안선알매적환인분별재화료제45천화210천시학진；기여4례재조혈간세포이식술후60 ～ 450 d시발생계발성당뇨병.15례이당피질격소위주요치료적환인재치료후2 d～4.7년시피학진위당뇨병.저사환인균무당뇨병적전형증상,무합병당뇨병동증산중독자.Logistic회귀분석현시,년령교대자발생계발성당뇨병적풍험시교소자적1.24배[95％가신구간(CI):1.08 ～ 1.42,P ＜0.05],비반인시정상체중인적5.08배(95％ CI:2.02 ～ 12.78,P＜0.05).결론 본연구현시국내인동계발성당뇨병환병솔교국외저,병인성별년령단화원발병충적불동이불동；계발성당뇨병증상불전형,역루진,질병전정수요감측혈당.
Objective To investigate the prevalence and association factors of secondary diabetes in Chinese hospitalized children.Methods A case-control design,retrospective study on pediatric patients ＜ 18 years,who were hospitalized in Beijing Children's Hospital between Jan.2002 and Dec.2010 was carried out.Diabetes was diagnosed according to the criteria of World Health Orgnization (WHO),1999.Control cases were chosen with 1:4 ratio and matched in the primary diseases,age,gender.The associated risk factors of secondary diabetes was investigated with logistic analysis.Results Total 33 cases (aged 7.1-16.4 years,15 boys and 18 girls) of secondary diabetes were identified among 9657 inpatients suffering the corresponding primary diseases.The total prevalence of secondary diabetes was 0.34％,the highest was 4.17％ in lymphoma leukemia,then 3.70％ in acute lymphoblastic leukemia after hematopoietic stem cell transplantation,1.67％ in multiple sclerosis and less than 1.0％ in systemic lupus erythematosus,dermatomyositis,acute lymphoblastic leukemia without hematopoietic stem cell transplantation,histocytosis,idiopathic thrombocytopenic purpura,nephropathy and purpuric nephritis.The prevalence of secondary diabetes was lower in boy than that in girls(0.24％ vs 0.53％,x2 =4.79,P ＜0.05).There were 18 cases of secondary diabetes suffering hematological malignancies and 12 cases of them developed diabetes within 6 days after L-asparaginase treatment; 2 cases with chemotherapy with non-L-asparaginase-based regimens developed diabetes at day 45 and 210 respectively,and the rest 4 patients developed diabetes during days 60 to 450 after hematopoietic stem cell transplantation.Of the patients treated mainly with corticosteroid,15 cases were identified with diabetes 2 days to 4.7 years after the treatment.None of them had typical symptoms and diabetic ketone acidosis.Logistic regression showed that age and obesity or overweight were the risk factors for secondary diabetes (the odds ratio was 1.24 and 5.08 respectively,both P ＜ 0.05).Conclusion It's indicated that the prevalence of secondary diabetes in hospitalized children was lower in China than that in western countries and differs with gender,age and various primary diseases.Secondary diabetes can be easily miss-diagnosed due to the atypical symptoms.It is necessary to monitor glucose during the whole course of the primary diseases.
