糖尿病酮症或酮症酸中毒起病的成人新诊断糖尿病患者临床特征及分型诊断  

Clinical characteristics and classification diagnosis of newly diagnosed diabetes onset with ketosis or ketoacidosis in adult patients

作　　者：刘宏霞[1] 李贵梅 周泳雯 骆斯慧[1] 郑雪瑛[1] 杨黛稚[1] 梁华[1] 严晋华[1] 姚斌[1] 翁建平[1] Liu Hongxia;Li Guimei;Zhou Yongwen;Luo Sihui;Zheng Xueying;Yang Daizhi;Liang Hua;Yan Jinhua;Yao Bin;Weng Jianping(Department of Endocrinology and Metabolic Disease,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diabetology,Guangzhou 510630,China;Department of Endocrinology,Qujing First People′s Hospital,Qujing 655000,Yunnan,China)

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科,广东省糖尿病防治重点实验室,广州510630 [2]曲靖市第一人民医院内分泌科,云南曲靖655000

出　　处：《中华医学杂志》2019年第18期1369-1374,共6页National Medical Journal of China

基　　金：国家重点研发计划(2017YFC1309603);广东省科技计划项目(2017A070713011);广州市科技计划项目(201508020027).

摘　　要：目的探讨以糖尿病酮症(DK)或糖尿病酮症酸中毒(DKA)起病的成人新诊断糖尿病患者的临床特征,为其分型诊断提供依据。方法回顾性分析中山大学附属第三医院2011年1月1日至2016年8月31日期间住院患者资料,入选DA或DKA起病、诊断年龄≥18岁的新诊断糖尿病患者。分析出院诊断为1型糖尿病(T1DM)、2型糖尿病(T2DM)、糖尿病未分型三组患者的临床特征。通过住院和门诊病案系统追踪患者出院2年内的用药情况和最终诊断,利用受试者工作特征曲线(ROC)评价起病年龄、体质指数(BMI)和C肽等临床指标对T1DM和T2DM的诊断价值及最佳诊断切点。结果共123例(男88例)患者纳入分析,年龄(41.1±13.6)岁。出院诊断为T1DM、T2DM和未分型的例数分别为37(30.1%)、60(48.8%)和26例(21.1%),三组患者在起病年龄,BMI,血压,血气pH值及碳酸氢根,血脂,空腹、0.5h及2h C肽水平,任一糖尿病自身抗体及谷氨酸脱羧酶抗体(GADA)阳性率,合并脂肪肝比例和糖尿病家族史比例差异均有统计学意义(均P<0.05)。对2年随访后确诊为T1DM(36例)和T2DM(87例)的患者行ROC曲线分析,结果显示起病年龄、BMI、空腹C肽、0.5h C肽及2h C肽作为诊断指标时的曲线下面积(AUC)分别为0.735、0.813、0.855、0.898、0.882。结论C肽、起病年龄和BMI等临床特点对DK或DKA起病的成人新诊断患者具有较好的分型诊断价值,且C肽的诊断价值优于BMI和年龄。Objective To describe the clinical characteristics and classification diagnosis of newly diagnosed diabetes onset with ketosis or ketoacidosis in adult patients.Methods Medical records of newly diagnosed diabetes onset with ketosis or ketoacidosis in the Third Affiliated Hospital of Sun Yat-sen University between January 2011 and August 2016 were reviewed.Patients aged 18 years or older were included,while other diseases that may cause urinary ketoacidosis and special types of diabetes were excluded.Patients were classified as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or diabetes mellitus untyped based on discharged diagnosis,and groups were compared for differences in clinical profiles.Then the patient′s medication,final diagnosis and outcome within 2 years of discharge were tracked through the inpatient and the outpatient medical record systems.Receiver operating characteristics (ROC) curves were analyzed to check the ability of clinical indicators such as onset age,body mass index (BMI) and C-peptide to discriminate T1DM from T2DM,and to find the best diagnostic cut-off points.Results A total of 123 patients (88 males) were enrolled [with a mean age of (41.1±13.6) years old],with 37 patients (30.1%) diagnosed as T1DM,60 patients (48.8%) diagnosed as T2DM and 26 patients (21.1%) diagnosed as Untyped.There was a statistically significant difference in onset age,BMI,blood pressure,blood gas pH and bicarbonate,blood lipids,fasting,0.5 h and 2 h C-peptide level,any diabetic antibody and anti-glutamic acid decarboxylase antibody (GADA) positive rate,combined fatty liver ratio and family history among the three groups (all P<0.05).ROC curve analysis was performed on patients diagnosed with T1DM (n=36) and T2DM (n=87) after 2 years follow-up,and the area under the curve (AUC) of onset age,BMI,fasting C-peptide,0.5 h and 2 h C-peptide was 0.735,0.813,0.855,0.898,and 0.882,respectively.Conclusion The ROC curve analysis indicates that C-peptide,onset age and BMI can provide effective diagnosti

关 键 词：糖尿病 1型 糖尿病 2型 糖尿病酮症酸中毒 

分 类 号：R587.2[医药卫生—内分泌]