CAJ | 학술논문

目的：探讨暴发性1型糖尿病(fulminant type 1 diabetes mellitus, FT1DM)的临床及诊治特点,提高该病的诊治水平。方法回顾性分析2010年1月—2014年1月贵州省人民医院收治的4例暴发性l型糖尿病的临床资料。结果本组以严重酮症酸中毒为特征,症状多样,起病急骤,平均病程4.5 d,均有多饮、多尿,伴明显恶心、呕吐、腹部不适等消化系统症状,1例因昏迷入院。除1例剑突下压痛外,余急腹症体征不明显。4例中1例曾误诊为急性胃肠炎,给予补充葡萄糖治疗后病情加重入我院。4例入院时随机血糖28.3~46．5 mmol/L,糖化血红蛋白6.0%~6．7%,平均空腹C肽0.18 ng/ml,平均餐后2 h C肽0.30 ng/ml,确诊为FT1DM,予胰岛素等综合治疗。随访0.5~2．5年胰岛β细胞功能无明显改善。结论 FT1DM代谢紊乱严重,胰岛β细胞功能衰竭且不可逆,加之临床表现多样,常合并多器官功能损害,易误诊,病死率较高。
목적：탐토폭발성1형당뇨병(fulminant type 1 diabetes mellitus, FT1DM)적림상급진치특점,제고해병적진치수평。방법회고성분석2010년1월—2014년1월귀주성인민의원수치적4례폭발성l형당뇨병적림상자료。결과본조이엄중동증산중독위특정,증상다양,기병급취,평균병정4.5 d,균유다음、다뇨,반명현악심、구토、복부불괄등소화계통증상,1례인혼미입원。제1례검돌하압통외,여급복증체정불명현。4례중1례증오진위급성위장염,급여보충포도당치료후병정가중입아원。4례입원시수궤혈당28.3~46．5 mmol/L,당화혈홍단백6.0%~6．7%,평균공복C태0.18 ng/ml,평균찬후2 h C태0.30 ng/ml,학진위FT1DM,여이도소등종합치료。수방0.5~2．5년이도β세포공능무명현개선。결론 FT1DM대사문란엄중,이도β세포공능쇠갈차불가역,가지림상표현다양,상합병다기관공능손해,역오진,병사솔교고。
Objective To investigate the clinical diagnosis, treatment features of fulminant Type 1 diabetes mellitus (FT1DM) and improve the level of diagnosis. Methods Retrospective analysis of clinical data of 4 patients with FT1DM admit-ted to the People's Hospital of Guizhou Province during January 2010 and January 2014 was made. Results Symptoms of the pa-tients suffering from FT1DM were characterized by severe ketoacidosis, diversity of symptoms and a rapid onset. The average du-ration was 4. 5 d. All the patients had symptoms of being thirsty and polyuria. And most of the patients had obvious symptoms of nausea, vomiting and abdominal discomfort. 1 patient was admitted for coma. Except for 1 case with pressing pain under the xiphoid bone,,the signs of acute abdominal pain in the other patients were not obvious. 1 case was misdiagnosed as acute gastro-enteritis, and was given glucose treatment, and then the condition aggravated and the patient was transferred to our hospital. The level of blood glucose at random was 28. 3~46. 5 mmol/L, glycosylated hemoglobin was 6. 0% ~6. 7%. The mean of FCP was 0. 18 ng/ml and 2 hCP was 0. 30 ng/ml. All the four cases were diagnosised as FT1DM. And all the patients received insulin therapy. The function of pancreatic beta cell function followed up from 0. 5 to 2. 5 years showed little sign of improvement. Con-clusion The metabolic disorder of FT1DM is a serious condition. Its insulin beta cell function will irreversibly fail. The mani-festations are diverse and often combined with multiple organ damage. It tends to be misdiagnosed and has a high mortality rate.