暴发性1型糖尿病合并急性胰腺炎1例及文献回顾  

Fulminant type 1 diabetes mellitus with acute pancreatitis: A case report and literature review

作　　者：张培恒 高莹[1] 吴红花[1] 张健[1] 张俊清[1] ZHANG Peiheng;GAO Ying;WU Honghua;ZHANG Jian;ZHANG Junqing(Department of Endocrinology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内分泌科,北京100034

出　　处：《北京大学学报（医学版）》2024年第5期923-927,共5页Journal of Peking University:Health Sciences

摘　　要：暴发性1型糖尿病(fulminant type 1 diabetes, FT1DM)是由日本学者Imagawa等^([1])首次报道的一种1型糖尿病(type 1 diabetes mellitus, T1DM)新亚型,其临床特点为起病急,进展快,胰岛β细胞急速损毁,高血糖症状持续时间很短即可出现糖尿病酮症或糖尿病酮症酸中毒(diabetic ketoacidosis, DKA),而糖化血红蛋白为正常或仅轻度升高,糖尿病相关自身抗体阴性。The objective was to report a relatively rare case of fulminant type 1 diabetes (FT1DM) complicated with acute pancreatitis (AP), to summarize the characteristics as well as experience of diagnosis and treatment, and to explore its pathogenesis. Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively. A 66-year-old male presented with acute fever and abdominal pain, accompanying with the significantly elevated pancreatic enzymes, and his abdominal CT scan showed exudation around the pancreas. The clinical manifestations mentioned above were consistent with the diagnosis of AP. Five days after onset, the patient developed clinical symptoms, such as obvious thirst, polyuria, polyasthenia and fatigue. Meanwhile, his plasma glucose increased significantly and the diabetic ketoacidosis (DKA) occurred. The patient ’ s fasting and postprandial 2 hours C peptide decreased significantly (all 0.02 μg/L), glycated hemoglobin level was not high (6%), and his islet-related autoantibodies were undetectable. Thus, the patient could be diagnosed with FT1DM. After the treatment of fasting, fluid replacement, anti-infection, somatostatin, anticoagulation and intravenous insulin sequential subcutaneous insulin pump, the patient gained the alleviation of pancreatitis, restoration of oral intake, and relatively stable blood glucose levels. Summarizing the characte- ristics of this case and reviewing the literature, FT1DM complicated with AP was relatively rare in FT1DM. Its common characteristics were described below: (1) Most cases started with AP and the blood glucose elevated within 1 week, or some cases had the simultaneously onset of AP and FT1DM. (2) The clinical course of AP was short and relieved no more than 1 week;Pancreatic imaging could completely return to normal within 1 to 4 weeks after onset. (3) The etiology of AP most was idiopathic;The elevation of pancreatic enzyme level was slight and the recovery was rapidly compared with AP of othe

关 键 词：糖尿病 1型 胰腺炎 急性病 

分 类 号：R587.1[医药卫生—内分泌]