暴发性1型糖尿病四例临床分析  

Retrospective Analysis of 4 Cases of Fulminant Type 1 Diabetes

作　　者：顾燕[1] 罗建华[1] 王亚林[1] 范元硕[1] 于瑞萍[1] 刘波[1] 何茜[1] 李雨珂[1] 

机构地区：[1]贵州省人民医院内分泌科,贵阳550002

出　　处：《临床误诊误治》2015年第8期20-23,共4页Clinical Misdiagnosis & Mistherapy

基　　金：贵阳市科学技术计划项目[(2009)筑科农合同字第3-003号]

摘　　要：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。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.

关 键 词：糖尿病 1型 糖尿病酮症酸中毒 误诊 胃肠炎 

分 类 号：R587.1[医药卫生—内分泌] R587.22[医药卫生—内科学]