外源性胰岛素致1型糖尿病患者严重水肿一例并文献复习  

Severe edema in type 1 diabetes caused by exogenous insulin： a case report and literature review

作　　者：刘巍 管胡琰 李乃适 夏维波 肖新华 Liu Wei;Guan Yueyan;Li Naishi;Xia Weibo;Xiao Xinhua(Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科卫生健康委员会内分泌重点实验室,100730

出　　处：《中华糖尿病杂志》2018年第8期552-556,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的探讨外源性胰岛素致l型糖尿病严重水肿的临床特点及预后。方法对32例1型糖尿病合并严重外源性胰岛素性水肿病例进行归纳总结，并回顾分析我院1例病例。结果出现严重胰岛素性水肿的1型糖尿病患者的临床特点：女性显著多于男性，女：男=3：1，年龄≤20岁的占71．9％（23／32），超过70％（11／15）患者存在低体重，新发1型糖尿病占56．25％（18／32），73．1％（19／26）患者发生水肿前存在糖尿病酮症酸中毒，糖化血红蛋白范围12％～19％，65％（13／20）患者胰岛素用量≤1．5U·kg^-1·d^-1，72％（18／25）患者使用胰岛素1周内出现水肿，全身性水肿占48．3％（14／29），周围性水肿占51．7％（15／29），浆膜腔积液占17．2％（5／29），20．7％（6／29）患者存在肝转氨酶升高，体重增加〉10kg的占30．4％（7／23），53．1％（17／32）患者水肿不经治疗自行消退，46．9％（15／32）患者经治疗后水肿消退，66．7％（18／27）患者的水肿在2周内消退。结论（1）在出现严重胰岛素性水肿的1型糖尿病患者中，女性更多见，低体重、血糖控制差、糖尿病酮症酸中毒等因素出现的频率高。（2）严重胰岛素性水肿是暂时性和自限性的。Objective To explore the clinical characteristics and prognosis of severe edema induced by exogenous insulin in type 1 diabetes mellitus. Methods A total of 32 patients with type 1 diabetes mellitus combined with severe insulin-induced edema were retrospectively analyzed in our hospital. Results The number of female patients were significantly more than those of male patients with a female/male ratio 3 ： 1. There were 71.9% （23/32） patients younger than 20 years old and more than 70% （11/15） patients were underweight. 56.25% （18/32） patients were newly diagnosed type 1 diabetes mellitus, and 73.1% （19/26） patients were complicated with diabetic ketoacidosis. HbA1c levels ranged from 12% to 19%, and 65% （13/20） patients received insulin treatment with the dosage ≤ 1.5 U·kg-^1· d^-1. Severe insulin-induced edema occurred within 1 week in 72% （18/25） patients, including 48.3%（14/29） patients with systemic edema, 51.7% （15/29） patients with peripheral edema and 17.2% （5/29） patients with serous effusion. Liver transaminase elevated in 20.7% （6/29） patients, and weight gained （because of edema） more than 10 kg in 30.4% （7/23） patients. Edema subsided spontaneously without diuretics therapy in 53.1% （17/32） patients, and edema subsided within 2 weeks in 66.7% （18/27） patients. Conclusions Females, underweight, poor blood glucose control and diabetic ketoacidosis occurr more frequently in type 1 diabetic patients with severe insulin-induced edema. Severe insulin-induced edema is transient and self-limiting, and can subside with or without diuretics therapy.

关 键 词：糖尿病 1型 水肿 胰岛素 

分 类 号：R459.1[医药卫生—治疗学]