慢性胰腺炎后糖尿病与2型糖尿病的临床特征观察  

Clinical observation of post-chronic pancreatitis diabetes mellitus patients and type 2 diabetes mellitus patients

作　　者：沈佩玲[1] 卢洁 石益海[2] 李波静[2] Shen Peiling;Lu Jie;Shi Yihai;Li Bojing(Department of Internal Medicine,Gongli Hospital,Pudong New Area,Shanghai 200135,China;Department of Gastroenterology,Gongli Hospital,Pudong New Area,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院内科,上海200135 [2]上海市浦东新区公利医院消化内科,上海200135

出　　处：《中华胰腺病杂志》2023年第3期207-211,共5页Chinese Journal of Pancreatology

基　　金：上海浦东新区卫生健康委员会胰胆结石专科建设项目(PWZy2020-05);上海浦东新区卫生健康委员会临床高峰学科建设项目(PWYgf2021-08);上海浦东新区科技发展基金民生科研专项项目(PKJ2021-Y10)。

摘　　要：目的上比较慢性胰腺炎后糖尿病(PPDM-C)与2型糖尿病(T2DM)患者的临床特征。方法回顾性分析2018年1月至2021年12月间上海市浦东新区公利医院住院确诊的142例CP患者的临床资料。根据是否并发糖尿病将患者分为无糖尿病的CP组(CP组,60例)和合并糖尿病的CP组(PPDM-C组,82例),同时选取同期住院确诊的无CP的T2DM患者作为对照组(T2DM组,82例)。记录患者的年龄、性别、体重指数、发病特征、人院时实验室检查指标(空腹血糖、糖化血红蛋白、血肌酐、谷丙转氨酶)、胰腺影像学特征(胰腺萎缩、胰腺多发钙化、胰管结石、胰管扩张及胰管梗阻)、糖尿病治疗措施及疗效。结果与T2DM组比较,PPDM-C组患者体重指数(22.06kg/m^(2)比24.40kg/m^(2))及糖化血红蛋白水平(7.34%比9.20%)显著下降(P值均<0.001),谷丙转氨酶水平显著升高(33.00U/L比18.65U/L,P=0.021);更容易出现上腹痛、恶心、呕吐、体重减轻、腹泻等症状;较少应用胰岛素和降糖药物联合治疗控制血糖。与CP组比较,PPDM-C组患者体重指数显著增高(22.06kg/m^(2)比21.18 kg/m^(2)),糖化血红蛋白(7.34%比5.70%)、空腹血糖(7.91mmol/L比5.31mmol/L)及谷丙转氨酶水平(33.00U/L比26.50U/L)显著升高,差异均有统计学意义(P值均<0.05);胰腺萎缩、胰管多发钙化、胰管梗阻发生率更高(P值均<0.05)。结论PPDM-C患者比T2DM患者更易出现腹痛等消化系统症状,而比CP患者更易发生胰腺功能受损。更多地关注PPDM-C相关的临床表现和生物化学指标及影像学变化,可以识别其潜在的风险患者,进行PPDM-C早期诊断和治疗。Objective To observe and compare the clinical characteristics between post-chronic pancreatitis diabetes mellitus(PPDM-C)patients and type 2 diabetes mellitus(T2DM).Methods Data of 142 cases of CP patients confirmed in Shanghai Pudong New Area Gongli Hospital from January 2018 to December 2021 were collected,all the patients were divided into CP group without diabetes mellitus(n=60)and PPDMC group with diabetes mellitus(n=82)based on whether with or without diabetes mellitus.And 82 cases T2DM without CP(T2DM group,n=82)hospitalized simultaneously were collected as control group.The age,sex,body mass index,onset characteristics,laboratory examination indicators at admission(fasting blood glucose,glycosylated hemoglobin,blood creatinine,and alanine transaminase),imaging characteristics of the pancreas(pancreatic atrophy,multiple calcifications of the pancreas,pancreatic duct stones,pancreatic duct dilation,and pancreatic duct obstruction),and treatments and efficacy of diabetes were recorded.Results Compared with T2DM group,PPDM-C group had lower body mass index(22.2 kg/m^(2)us 24.6 kg/m^(2)),and glycosylated hemoglobin levels(7.34%vs 9.20%)(all P values<0.001),higher alanine transaminase levels(33.00 U/L us 18.65 U/L,P=0.021).And they had more upper abdominal pain,nausea,vomiting,weight loss and diarrhea symptoms.In addition,they had less use of combination of insulin and hypoglycemic drugs to control blood glucose.And compared with CP group,PPDM-C group had higher body mass index(22.06 kg/m^(2)us 21.18 kg/m^(2)),higher glycosylated hemoglobin levels(7.34%vs 5.70%),higher fasting blood-glucose levels(7.91 mmol/1 us 5.31 mmol/1),higher alanine transaminase levels(33.00 U/L us 26.50U/L),and their differences were statistically significant(all P values<0.05).And they had higher incidence of pancreatic atrophy,multiple calcifications in the pancreatic duct and pancreatic duct obstruction(all P values<0.05).Conclusions PPDM-C patients are more likely to experience digestive system symptoms such as abdominal pain than T

关 键 词：胰腺炎 慢性 糖尿病 临床医学 

分 类 号：R587.1[医药卫生—内分泌] R576[医药卫生—内科学]