急骤起病伴胰酶增高的1型糖尿病临床和免疫学特征  

Clinical and immunological characteristics in rapid-onset type 1 diabetes with hyperamylasemia

作　　者：张弛[1] 周智广[1] 张冬梅[1] 杨晓琳[1] 周敏[2] 林健[1] 黄干[1] 王建平[1] 

机构地区：[1]中南大学湘雅二医院糖尿病中心代谢内分泌研究所,长沙410011 [2]中南大学湘雅医院内分泌科

出　　处：《中华医学杂志》2005年第14期967-971,共5页National Medical Journal of China

基　　金：国家自然科学基金资助项目(39370343);卫生部优秀青年科技人才专项基金资助项目(Q9420);教育部跨世纪人才基金资助项目(200248);湖南省卫生厅科研重点项目基金资助项目(A2004004)

摘　　要：目的探讨急骤起病伴胰酶增高的1型糖尿病的临床特征及其与胰岛自身抗体的关系。方法采用日本Imagawa对急骤起病1型糖尿病的诊断标准,从40例急性酮症或酮症酸中毒起病的1型糖尿病患者中,筛选出4例急骤起病的1型糖尿病患者(F组,n=4),与非急骤起病者(NF组,n=36)比较;再将症状1周内(A组,n=11)与1周以上的患者(B组,n=29)进行比较,并分析血清淀粉酶升高与患者酮症酸中毒严重程度的关系。用放射配体法检测谷氨酸脱羧酶抗体、蛋白酪氨酸磷酸酶抗体和胰岛素自身抗体。结果急骤起病的1型糖尿病占本组急性酮症或酮症酸中毒起病者的10%。4例急骤起病1型糖尿病患者中2例胰岛自身抗体阳性。糖尿病症状1周内的11例患者酮症酸中毒均为重度,其中10例血清淀粉酶增高;与症状1周以上患者比较,前者血糖更高,动脉血pH值和二氧化碳结合力更低,酮症酸中毒的程度更严重,血清淀粉酶增高比例更大,糖化血红蛋白更低,差异有统计学意义(P<0.05)。重度酮症酸中毒者(n=20)较轻中度酮症者(n=20)血清淀粉酶增高比例更大(60%vs.20%,P<0.05)。结论(1)中国人存在暴发性1型糖尿病;(2)急骤起病伴胰酶增高的1型糖尿病是一组临床综合征,有自身免疫和非自身免疫两类病因;(3)血清胰酶增高并非暴发性1型糖尿病特有,而主要由酮症酸中毒等严重代谢紊乱所致。Objective To investigate the clinical characteristics and different status of islet autoantibodies of rapid-onset type 1 diabetes in China with elevated serum pancreatic enzymes.Methods In accordance with the criteria Imagawa reported, 40 cases of acute-onset type 1 diabetics with ketosis or ketoacidosis were selected and 4 fell into the criteria of rapid-onset type 1 diabetes. Compared the clinical characteristics between fulminant (group F, n=4) and nonfulminant (group NF, n=36) type 1 diabetics. Same parameters were compared between the patients with diabetic symptoms within 1 week (group A, n=11) and those beyond 1week (group B, n=29).The percentage of elevated serum amylase were compared between patients with and without severe ketoacidosis. Islet autoantibodies, including glutamic acid decarboxylase antibody (GAD-Ab), protein tyrosine phosphatase antibody (IA-2Ab) and insulin autoantibody (IAA) , were detected by radioligand assays. Results We found 4 cases of rapid-onset type 1 diabetes in Chinese, accounted for 10% of acute-onset type 1 diabetes. Among 4 rapid-onset type 1 diabetics, 2 patients detected GAD-Ab positive. Patients with duration of diabetic symptoms within 1 week (group A) were found all with severe ketoacidosis and 10 of 11 patients were found serum amylase elevated and this group appeared higher blood glucose, lower PH and CO_2CP , nearly normal HbA_1c and more severe ketoacidosis, more patients with elevated amylase (P<0.05) than those with duration of symptoms more than 1 week (group B).Patients with severe ketoacidosis(n=20) owned higher percentage of elevated serum amylase than those with mild or moderate ketoacidosis (n=20) (60%vs 20%, P<0.05). Conclusion (1) Rapid-onset type 1 diabetes cases are also observed in China. (2) Rapid-onset type 1 diabetes may be a group of syndromes with different etiology which immune and non-immune factors may both involved in. (3) Elevated pancreatic enzymes are not specific markers for rapid-onset type 1 diabetes, it may result from severe ketoacidosi

关 键 词：1型糖尿病 免疫学特征 增高 酮症或酮症酸中毒 蛋白酪氨酸磷酸酶抗体 谷氨酸脱羧酶抗体 糖尿病患者 血清淀粉酶升高 胰岛素自身抗体 二氧化碳结合力 胰岛自身抗体 动脉血pH值 糖化血红蛋白 自身免疫 放射配体法 临床综合征 

分 类 号：R587.1[医药卫生—内分泌] R161[医药卫生—内科学]