广东省1型糖尿病患者酮症酸中毒发病率及其危险因素分析  

Incidence and related risk factors of diabetic ketoacidosis in Guangdong type 1 diabetics

作　　者：严晋华[1] 杨黛稚[1] 邓洪容[1] 李津[1] 翁建平[1] 

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科,广州510630

出　　处：《中华医学杂志》2013年第12期897-901,共5页National Medical Journal of China

基　　金：国家自然科学基金（81100556）;广东省科技计划项目（20108031500008）;广东省自然科学基金（S2011010005078）

摘　　要：目的调查广东省1型糖尿病患者糖尿病酮症酸中毒（DKA）的发病率及其危险因素。方法2010年8月6日至2012年3月31日在广东省16家医院收集1型糖尿病患者的人口学资料、病史等信息，中心化检测糖化血红蛋白（HbA，。）和固定餐后2hC肽等；DKA发病和复发的危险因素分别采用Poisson回归模型和Logistic回归模型分析。结果共纳入611例1型糖尿病患者，DKA发病率为26．4次／100人年，发病危险因素有女性（RR=2．12）、医保报销比例〈50％（RR=1．84）、未控制饮食（RR=1．76）、吸烟（RR=2．18）和血糖控制差（RR=1．15）。34．4％的DKA集中发生在3．8％有复发史的患者，复发的危险因素有女性（RR=10．56）、吸烟（RR=6．99）、胰岛功能差（RR=4．22）和血糖控制差（RR=1．16）。结论广东省1型糖尿病患者DKA发病率高，且易复发；与一些可纠正的危险因素相关。Objective To determine the incidence and the predictors of diabetes ketoacidosis （DKA） in Chinese type 1 diabetics so as to lay a foundation for better prevention and treatment. Methods For this cross-sectional study, a total of 611 patients with established type 1 diabetes between August 6, 2010 and March 31, 2012 were recruited from 16 hospitals in Guangdong Province. And 491 of them were over 18 years old. A data entry form was used to collect the patient information on demographics, medical history, acute/chronic complications, smoking/drinking status, diet, exercise, physical examination and treatment, etc. Hemoglobin A1c （HbA1c） and stimulated C peptide levels were centrally measured. The incidence rate of diabetic ketoacidosis （DKA） was calculated at events per 100 patient-years. To determine the predictors of DKA, Poisson＇s regression model was used for analysis. And backward stepwise logistic regression analysis was performed to identify the predictors of DKA recurrence. The protocol and informed consent form were approved by Ethics Committee of Third Affiliated Hospital, Sun Yat-sen University. Written informed consent was obtained from patients （ age 〉 18 years ） or their legal guardians （ age 〈 18 years）. Results Among them, 53.7% were females. The mean age was 27. 8 years （ range： 19. 5 - 37.3 ）. The age of onset was 22. 7 （ 14. 0 - 31.4 ） years old and disease duration 4. 3 （ 1.7 - 7.9 ） years. Overweight and obese patients accounted for 10.8% and 1.0% respectively. Among them, the self- monitoring frequency of blood glucose was 0. 4 （0. 1 - 1.4） times per day. Overall, 26.4% patients reached the target of age-specific HbA1c values. The overall incidence of DKA was 26. 4 per 100 patient-years. Significant predictors of DKA in the Poisson regression model were females （RR = 2. 12） , medical insurance claiming percentage below 50% （RR = 1.84 ）, uncontrolled diet （never controlled diet vs. usually controlled diet, RR = 1.76）, smoking （RR = 2. 18

关 键 词：糖尿病 1型 广东 糖尿病酮症酸中毒 

分 类 号：R587.1[医药卫生—内分泌]