基于病例系列分析的胰腺纤维钙化性糖尿病诊断与鉴别诊断探讨  

A case series of fibrocalculous pancreatic diabetes and insights into its diagnosis and differential diagnosis

作　　者：李佳 谭文彬 陈炯镇 朱凯旋 LI Jia;TAN Wenbin;CHEN Jiongzhen;ZHU Kaixuan(Department of Endocrinology,General Hospital of Southern Theater Command,PLA,Guangzhou 510010,Guangdong Province,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]南部战区总医院内分泌科,广东广州510010 [2]南方医科大学第一临床医学院,广东广州510515

出　　处：《解放军医学院学报》2024年第1期18-23,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景胰腺纤维钙化性糖尿病(fibrocalculous pancreatic diabetes,FCPD)诊断标准更新相对滞后,早期识别及干预可改善预后,但与其他类型糖尿病存在鉴别诊断难点。目的探讨FCPD有效诊断及其与1型糖尿病(type 1 diabetes mellitus,T1DM)、2型糖尿病(type 2 diabetes mellitus,T2DM)、酒精性慢性胰腺炎(alcoholic chronic pancreatitis,ACP)继发性糖尿病的鉴别要点,为FCPD诊治提供新思路。方法回顾分析南部战区总医院2006年4月—2020年4月收治的3例糖尿病伴胰腺钙化/结石患者的临床特点及诊治经过并复习相关文献。结果病例1,男性,30岁,考虑T1DM,胰腺不除外继发性改变;病例2,男性,33岁,符合FCPD表现;病例3,男性,43岁,考虑慢性胰腺炎伴胰腺结石,继发性糖尿病,不除外ACP和FCPD可能。3例患者均来自非热带地区,其中食用木薯者1例;3例均有不同程度饮酒史,1例自幼有腹痛症状,3例均否认脂肪泻｡3例均伴有胰岛功能减退,糖尿病相关抗体阳性2例,仅有1例出现酮症。分别通过B超、CT、MRI证实3例均存在胰腺钙化和(或)胰管结石。结论诊断需关注FCPD特征性胰腺结石和胰管扩张影像学改变。饮酒史不是鉴别FCPD与ACP继发性糖尿病的特异性条件。Background The diagnostic criteria of fibrocalculous pancreatic diabetes(FCPD)are relatively lagging behind.Early identification and intervention can improve the prognosis,but it is difficult to differentiate FCPD from other types of diabetes.Objective To investigate the diagnosis of FCPD,as well as the differentiation between FCPD and type 1 diabetes(T1DM),type 2 diabetes(T2DM)and alcoholic chronic pancreatitis(ACP)secondary diabetes,so as to provide new ideas for the diagnosis and treatment of FCPD.Methods The clinical characteristics,diagnosis and treatment of 3 diabetic patients with pancreatic calcification or pancreatic calculi in our hospital from April 2006 to April 2020 were analyzed,and the relevant literatures were reviewed.Results Case 1 was a 30-year-old male with T1DM,and secondary changes in the pancreas were not excluded.Case 2 was a 33-year-old male with typical FCPD characteristics.Case 3 was a 43-year-old male,diagnosed as chronic pancreatitis with pancreatic stones and secondary diabetes,ACP or FCPD were considered.All three patients came from non-tropical areas,including one case ate cassava and they all had a history of drinking in different degrees.One patient had abdominal pain since childhood,and all three patients denied lipodiarrhea.All three patients were accompanied by islet dysfunction,2 patients were positive for diabetes-related antibodies,and only one patient developed ketosis.Pancreatic calcification and pancreatic duct stones were confirmed by ultrasound,CT and MRI respectively.Conclusion More attention should be paid to the characteristic imaging changes of pancreatic calculus and pancreatic duct dilation in the diagnosis of FCPD.History of alcohol consumption is not a specific condition to differentiate FCPD from ACP secondary diabetes.

关 键 词：胰腺纤维钙化性糖尿病 1型糖尿病 2型糖尿病 酒精性胰腺炎 鉴别诊断 

分 类 号：R587.1[医药卫生—内分泌] R576[医药卫生—内科学]