暴发性1型糖尿病的患病状况及其特征

目的 探讨暴发性1型糖尿病(F1D)的患病状况和临床特征.方法 采用Hanafusa提出的诊断标准,从中南大学湘雅二医院急性酮症起病的1型糖尿病患者中筛选F1D患者,再根据胰岛自身抗体谷氨酸脱羧酶抗体(GADA)或蛋白酪氨酸磷酸酶抗体的有无将非F1D患者分为经典1型组和特发1型组,比较3组患者临床特征的差异.结果 87例急性酮症起病的1犁糖尿病患者中有8例符合F1D的诊断标准,占9.1%,在18岁以上患者中占14.0%.起病时暴发组的血糖显著高于经典1型组和特发1型组(P=0.004);暴发组血淀粉酶水平显著高于经典1型组(P=0.021).4例(50%)患者发病初期GADA阳性,其中1例柯萨奇病毒B(CVB)IgM阳性,1例人单纯疱疹病毒1(HSV1)IgM阳性.结论 F1D约占以酮症或酮症酸中毒起病的1型糖尿病患者的10%.起病时F1D患者比经典1型和特发1型糖尿病患者有更严重的代谢紊乱.病毒感染和自身免疫可能参与其发病过程.

Prevalence and clinical features of fulminant type 1 diabetes

Objective To investigate the prevalence and clinical features of fulminant type 1 diabetes.Methods Using data retrieved from Second Xiangya Hospital of Central South University,all patients diagnosed with type 1 diabetes from Jan.1,2001 to Dec.31,2007 were identified.The patients were divided into fulminant type 1 diabetes (F1D) group,typical type 1 diabetes (T1A) group,and idiopathic type 1 diabetes(T1B) group.Their clinical features were compared.Results Eight patients (9.1%) fulfilled the criteria for fulminant type 1 diabetes among 87 newly diagnosed type 1 diabetes,and the percentage of fulminant type 1 diabetes reached 14.0% among type 1 diabetic patients with age of onset of 18 years or older.Patients of F1D group had a markedly higher plasma glucose concentration compared with patients of T1A group and T1B group(P=0.004).Serum amylase was higher in F1D group than that in T1A group(P = 0.021).Four (50%) patients were GADA positive,among whom 1 patient was Coxsackie B virus (CVB) IgM positive and 1 patient was Herpes Simplex virus 1 (HSV1) IgM positive.Conclusions Fulminant type 1 diabetes accounts for about 10% of the type 1 diabetes in the Chinese individuals with ketosis-or ketoacidosis-onset.Patients with this subset of diabetes had severe metabolic derangement.Viral infection and autoimmunity may be involved in the pathogenesis of fulminant type 1 diabetes.