以住院患儿为基础的儿童继发性糖尿病患病率调查及相关因素分析  

Hospital based prevalence survey of secondary diabetes and its related factors

作　　者：李豫川[1] 曹冰燕[1] 巩纯秀[1] 梁学军[1] 王琳琳[1] 

机构地区：[1]首都医科大学附属北京儿童医院内分泌遗传代谢科,100045

出　　处：《中华糖尿病杂志》2013年第8期477-480,共4页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：基金项目：首都医学发展科研基金（2009-1046）

摘　　要：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％，x。=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一天冬氨酰胺酶治疗6d内发生了继发性糖尿病；2例未使用L一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60～450d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2d～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。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 （

关 键 词：糖尿病 儿童 住院 患病率 

分 类 号：R587.1[医药卫生—内分泌]