儿童糖尿病酮症酸中毒的临床特征及相关影响因素分析  

Analysis of clinical features and related influencing factors of diabetic ketoacidosis in children

作　　者：王静[1] 刘莉[1] 程安娜 王韧健 陈婷婷[1] 许秀何 黄玉娟 WANG Jing;LIU Li;CHENG Anna;WANG Renjian;CHEN Tingting;XU Xiuhe;HUANG Yujuan(Department of Emergency,Shanghai Children’s Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Pediatrics,Shanghai Shibei Hospital,Shanghai 200435,China)

机构地区：[1]上海市儿童医院、上海交通大学医学院附属儿童医院急诊科,上海200062 [2]上海市北医院儿科,上海200435

出　　处：《临床儿科杂志》2024年第4期333-338,共6页Journal of Clinical Pediatrics

基　　金：2021年静安区医学学科资助课题(No.2021BR06);小儿内科专科联盟(No.SHDC22021305-A,No.SHDC22021305-B)。

摘　　要：目的探讨以糖尿病酮症酸中毒(DKA)起病的新发1型糖尿病(T1DM)儿童的临床特征及相关影响因素,以提高临床医师对DKA高危患儿的早期识别,改善DKA患儿生存预后。方法回顾性分析2015年1月1日至2021年12月31日收治的214例新发T1DM的患儿资料,分为DKA组和NDKA组,比较两组临床特征及实验室检查。采用多因素logistic回归分析儿童DKA发生的相关影响因素。结果214例新发T1DM患儿,DKA组110例(51.4%),NDKA组104例(48.6%)。多饮、多尿、多食、体重减轻等典型糖尿病症状多见于NDKA组,胃肠道症状、神经精神状态改变、脱水症等多见于DKA组(P<0.05)。将单因素分析有意义的变量(年龄、前驱感染、症状持续时间、血浆C肽、血糖)进一步纳入多因素logistic回归分析显示,前驱感染(OR=7.541,95%CI:3.315~17.151),症状持续时间(OR=0.989,95%CI:0.980~0.999),血清C肽(OR=3.044,95%CI:1.571~5.899)和血糖(OR=5.652,95%CI:2.582~12.373)是儿童DKA发生的独立影响因素。结论T1DM患儿具有前驱感染、症状持续时间短、低血浆C肽和高血糖应警惕发展为DKA。Objective To investigate the clinical features and related influencing factors of newly diagnosed type 1 diabetes mellitus(T 1 DM)starting with diabetic ketoacidosis(DKA)in children,in order to improve the early identification of high-risk DKA children by clinicians and improve their survival prognosis.Methods The clinical data of 214 newly diagnosed children with T 1 DM admitted to the hospital from January 1,2015 to December 31,2021 were retrospectively analyzed.The patients were divided into DKA group and non-DKA(NDKA)group and the clinical features and laboratory examination were compared between the two groups.The multivariate logistic regression analysis was used to identify the related influencing factors of DKA occurrence in children.Results A total of 214 newly diagnosed T 1 DM children were included,110 patients(51.4%)in the DKA group and 104(48.6%)in the NDKA group.The typical clinical symptoms of diabetes such as polydipsia,polyuria,polyphagia and weight loss were more common in NDKA group,while gastrointestinal symptoms,neuropsychiatric changes and dehydration were more common in DKA group(P<0.05).The variables that were significant in univariate analysis(age,preceding infection,symptom duration,plasma C-peptide and blood glucose)were further included in multivariate logistic regression analysis,and the results showed that preceding infection(OR=7.541,95%CI:3.315-17.151),symptom duration(OR=0.989,95%CI:0.980-0.999),plasma C-peptide(OR=3.044,95%CI:1.571-5.899)and blood glucose(OR=5.652,95%CI:2.582-12.373)were independent factors influencing the occurrence of DKA in children.Conclusions Children with newly diagnosed T 1 DM should be cautious of developing DKA if they have a history of preceding infection,short-term symptoms,low plasma C-peptide,and high blood sugar.

关 键 词：1型糖尿病 糖尿病酮症酸中毒 影响因素 儿童 

分 类 号：R725[医药卫生—儿科]