初发1型糖尿病患儿酮症酸中毒的调查

目的调查初发1型糖尿病患儿酮症酸中毒(DKA)的发生情况。方法以224例初发1型糖尿病患儿为研究对象,进行回顾性分析,分为DKA组和未合并DKA组,各112例。DKA组患儿根据年龄分为≥5岁组(65例)和5岁组(47例),并根据酸中毒情况分为轻度(26例)、中度(29例)、重度(57例)3组。分析DKA发生的影响因素以及不同年龄DKA患儿的临床及实验室特点。结果 224例初发1型糖尿病患儿中最常见的症状为多饮(86.2%)、多尿(78.6%)及体重下降(57.1%)。与未合并DKA患儿比较,DKA组5岁、低收入、父母教育程度高中及以下所占的比例均较高,随机血糖、Hb A1C水平较高,pH、HCO_3~-及C肽水平更低,差异均具有统计学意义(P0.05)。≥5岁组与5岁组的轻、中、重度DKA所占比例的差异无统计学意义(P0.05)。与5岁组相比,≥5岁组DKA患儿的症状持续时间较长,随机血糖较低,HbA1C、C肽水平较高,差异具有统计学意义(P0.05)。结论 1型糖尿病患儿DKA发生率高,DKA的发生与年龄、父母文化程度及家庭收入有关。     

儿童糖尿病合并酮症酸中毒和高血糖高渗状态临床特征分析

目的了解儿童糖尿病合并酮症酸中毒(DKA)和高血糖高渗状态(HHS)的临床特征。方法依据诊断标准,从1995年1月至2009年12月新确诊的糖尿病患儿中筛选DKA和HHS患儿,比较糖尿病同时合并DKA和HHS(DKA-HHS)与单纯DKA患儿的临床特点。结果 1 065例新诊断儿童糖尿病患儿中有483例合并DKA,占45.35%;16例符合DKA-HHS,占1.50%;无单纯HHS糖尿病患儿。HHS在DKA患儿中的发生率为3.31%,其中1型糖尿病14例,2型糖尿病2例。HHS在年龄≥10岁的DKA患儿中的发生率明显高于小年龄患儿(χ2=6.05,P<0.05)。DKA-HHS患儿中重度脱水的比例、平均有效渗透压、血糖、三酰甘油及尿素氮水平均显著高于单纯DKA患儿,且酸中毒程度明显重于单纯DKA患儿,差异均有统计学意义(P均<0.05);DKA-HHS患儿的校正血清钠水平显著高于单纯DKA患儿,差异有统计学意义(P<0.05)。结论新诊断糖尿病患儿的HHS发生率较DKA低,且均与DKA合并存在;更常见于≥10岁患儿;DKA-HHS较单纯DKA患儿的代谢紊乱程度、脱水及酸中毒程度更严重,肾功能异常率更高。     

儿童1型糖尿病的10年回顾及白介素-10在糖尿病酮症酸中毒中的临床意义

目的：回顾浙江大学医学院附属儿童医院10年来住院儿童 1 型糖尿病的发病状况并探讨白介素-10（IL-10）在儿童 1 型糖尿病酮症酸中毒（DKA）中的临床意义。方法：对1999年1月至2009年2月在该院住院的263例334例次1型糖尿病患儿的临床资料进行回顾性分析;并对其中48例1型糖尿病患儿进行血脂、细胞因子等检查,根据有无酮症酸中毒分为 DKA组和非DKA组,24例正常健康儿童作为对照组,比较各组间血脂、细胞因子等参数的差异。结果：儿童1型糖尿病患儿中,女性多见（56.3%）,发病年龄以6~11.9岁多见。32.7% 的患儿以酮症酸中毒为就诊表现。DKA组血脂、血糖及糖化血红蛋白均高于非DKA组,二分类logistic 回归分析示上述指标水平的升高均为酮症酸中毒的危险因素。IL-10水平在DKA组明显升高,余细胞因子在DKA组和非DKA组无明显差异。糖尿病组各细胞因子水平明显高于正常对照组。结论：1型糖尿病患儿酮症酸中毒发生率较高,糖、脂代谢紊乱是酮症酸中毒的危险因素。IL-10可能为酮症酸中毒的敏感指标。［中国当代儿科杂志,2010,12（11）：849-854］     

浙江省1999～2004年新诊断儿童1型糖尿病流行病学特征及血脂水平

目的 探讨浙江省新诊断儿童1型糖尿病（DM）患儿流行病学特征及血脂特点。方法对1999年1月1日～2004年12月31日住院且为首次发病的101例1型DM患儿的年龄发病时间、出生时间、酮症酸中毒（DKA）及血脂特点进行回顾性分析。结果2004年新诊断的1型DM病人与总住院人数之比高于1999年；男童中12岁以上组病例所占同性别比例高于同年龄组女童（27．5％vs4．9％）.新诊断1型DM患儿出生于10月份至次年1月份者多于2～5月份出生者，同期发病的病例与总住院人数之比也明显升高。新诊断病例DKA组血糖和糖化血红蛋白（HbAlc）较非DKA组明显升高。两组总胆固醇（TC）和三酰甘油（TG）有显著性差异。血脂异常组与血脂正常组并DKA的比率有显著性差异，两组血糖、HbAlc和住院时间差异有显著性。结论儿童1型DM与总住院人数之比早逐年上升趋势；其发病可能与青春发育有关。初发1型DM患儿的DKA发生率又有回升。1型DM患儿TC、TG与血糖和HbAlc水平相关。     

~(13)碳尿素呼吸试验在诊断儿童幽门螺杆菌感染及评价疗效中的应用

目的　探讨13 碳尿素呼吸试验 (13 C UBT)在诊断儿童幽门螺杆菌 (Hp)感染及评价疗效中的应用。方法　应用13 C UBT及血清Hp IgG检测 193例无症状儿童及 34 0例反复腹痛患儿Hp感染状况 ,将两项检测均为阳性的反复腹痛患儿 88例随机分为治疗组 (5 7例 )和安慰剂组 (31例 ) ,接受奥美拉唑、克拉霉素、羟氨苄青霉素 (阿莫西林 )三联治疗 ,疗程 1周。停药后 4周随访。结果　腹痛患儿13 C UBT及Hp IgG阳性率分别为 2 9.1%、5 2 .1% ,显著高于无症状儿 (11.4%、39.4% )。 2～、5～、10～ 14岁三组无症状患儿13 C UBT及Hp IgG阳性率随年龄增加 ,但差异无显著性 ,P >0 .0 5。三组患儿13 C UBT阳性率分别为 2 9%、2 9.1%、30 % ,与年龄无关 ,χ2 =0 .0 4,P >0 .0 5 ;而Hp IgG阳性率随年龄增加 (36 %、5 3.7%、70 % ) ,差异有显著性 ,χ2 =13.16 ,P <0 .0 0 5。 2～、5～ 10岁组 13 C UBT及5～、10～ 14组Hp IgG阳性率 ,腹痛患儿较无症状儿明显增高。治疗后治疗组及安慰剂组腹痛消失或好转的总有效率分别为 97%和 2 6 % ;Hp根除率分别为 88% ,10 % ,两组差异有显著性。结论　 (1)部分患儿反复腹痛与Hp感染密切相关 ,Hp感染随年龄增加 ,但症状性感染与年龄无关。 (2 ) 13 C UBT检测具有方法简单 ,准确性高 ,无损伤等     

1型糖尿病伴糖尿病酮症酸中毒患儿发生急性肾损伤的临床研究北大核心CSCD

目的评估1型糖尿病伴糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患儿发生急性肾损伤(acute kidney injury,AKI)的情况,探讨导致DKA患儿发生AKI的可能潜在因素。方法回顾性将2018年1月1日至2020年12月31日在南京医科大学附属儿童医院就诊的45例1型糖尿病伴DKA患儿,按照入院时是否合并AKI分为无AKI组(n=37)和合并AKI组(n=8)。收集两组患儿社会人口学资料,入院时的体检数据,包括身高、体重、血压和心率等,采用化学发光微粒免疫分析法测定患儿入院及出院时血肌酐和尿素氮等指标水平。采用多因素logistic回归模型分析1型糖尿病伴DKA患儿发生AKI的影响因素。结果45例患儿确诊中位年龄为9.2岁,8例(18%)入院时合并AKI的患儿中,6例为1期AKI,2例为3期AKI。血校正钠水平升高与1型糖尿病伴DKA患儿发生AKI密切相关(P<0.05),而入院时较高的胰岛素水平则不易发生AKI(P<0.05)。结论1型糖尿病伴DKA患儿AKI的发生率较高,临床上应积极纠正DKA,尽快控制血糖,并定期对这部分儿童病例进行肾功能复查和随访。[中国当代儿科杂志,2022,24(8):858-862]     

儿童1型糖尿病酮症酸中毒合并低磷血症临床研究

目的 总结儿童1型糖尿病酮症酸中毒（DKA）合并低磷血症的临床特点,探讨DKA治疗期间低磷血症的发生率及预后。方法 回顾性分析2016年1月至2020年6月于广州市妇女儿童医疗中心遗传与内分泌科住院治疗的133例合并DKA的1型糖尿病患儿临床资料,分析入院后4～24h血磷水平,并对影响儿童血磷变化的相关因素进行分析。结果 133例DKA患儿中男55例（41%）,女78例（59%）,年龄6月龄至15岁,平均年龄（6.7±3.9）岁,新发1型糖尿病占72%。75例（56%）患儿出现血磷降低,其中41例（31%）患儿血磷0.81～1.29 mmol/L,22例（16%）患儿血磷0.61～0.81mmol/L,10例（7.5%）患儿血磷0.38～0.61mmol/L,2例（1.5%）患儿血磷<0.38mmol/L。正常血磷组与低血磷组之间pH值、碳酸氢根（HCO3-）、碱剩余（BE-B）、血钾、血氯差异均有统计学意义。酸中毒、年龄≤5岁为影响儿童DKA时血磷降低严重程度的危险因素。75例低血磷患儿均未出现低磷血症相关临床症状,未补充磷酸盐治疗。34例血磷<0.81mmol/L的患儿...     

胰岛素泵治疗儿童1型糖尿病酮症酸中毒32例临床分析

目的 观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病酮症酸中毒(DKA)的疗效.方法 将2005-2008年收治的1型DKA患儿64例分为治疗组32例和对照组32例.治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注治疗.比较两组患儿血精变化、DKA纠正时间及住院时间.结果 治疗组血糖下降相对稳定,酸中毒纠正时间治疗组[(16.91±4.223)h]短于对照组[(23.31±3.797)h](P<0.001),且无反复.治疗过程中治疗组未出现低血糖,对照组出现1例.住院时间治疗组[(15.63±2.458)d]短于对照组[(20.88±3.348)d](P<0.001).结论 胰岛素泵持续皮下注射胰岛索治疗儿童1型糖尿病酮症酸中毒安全有效.     

胰岛素泵治疗儿童1型糖尿病并酮症或酮症酸中毒26例

目的观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病并酮症或酮症酸中毒(DK/DKA)的疗效。方法本院内分泌科2003~2005年收治的1型糖尿病并DK/DKA患儿43例,分为治疗组26例和对照组17例。治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注。比较二组患儿血糖、尿酮体、血pH值变化,住院时间长短。结果1.治疗组血糖下降相对稳定,纠正酸中毒后无反复。2.治疗过程中治疗组未出现低血糖,对照组2例出现。3.住院时间治疗组[(11.92±4.72)d]较对照组[(17.35±4.83)d]治疗组较对照组明显缩短(P<0.001)。结论胰岛素泵持续皮下注射胰岛素治疗儿童1型糖尿病并DK/DKA是安全有效的。     

已确诊的1型糖尿病患儿病程中酮症酸中毒发生情况及诱因调查

目的 调查已确诊的1型糖尿病（T1DM）患儿病程中糖尿病酮症酸中毒（DKA）的发生情况。方法 以首都医科大学附属北京儿童医院、上海交通大学附属儿童医院、南京医科大学附属南京儿童医院、郑州市儿童医院、江西省儿童医院、西安交通大学第一附属医院、昆明医科大学第一附属医院、武汉市妇女儿童医疗保健中心、苏州大学附属儿童医院、聊城儿童医院、福建省福州儿童医院、成都市妇女儿童中心医院12家医院登记系统为基础调查多中心1995年12月至2014年6月胰岛素治疗下的已确诊T1DM患者病程中发生DKA的频度和诱发原因。其中,T1DM确诊后发生的第1次DKA为组1A,第2次DKA为组1B。选择北京儿童医院2011年12月-至2012年5月T1DM患者血糖控制状况横断面调查病程中无DKA发生者为对照组,即组2。结果 12家医院共新诊断了1676例T1DM患儿,其中89例患者在病程中发生了100次DKA,发生比率为5.3%（89/1676）,发生频率为5.9%（100/1676）。且各中心的DKA发生比率不同,波动在1.1%～24.1%之间。组1A的糖化血红蛋白（HbA1c）［（11.31±3.03）% vs.（8.26±1.53）%,P＜0.01］及胰岛素剂量［（0.85±0.42）IU vs.（ 0.71±0.31）IU,P＜0.01］明显高于组2。组1A的胰岛素泵使用率高于组2（25.0% vs. 11.2%,P＝0.01）。而且,前者的自我血糖监测达标率（12.1% vs. 40.1%, P＜0.01）及复诊次数达标率（21.2% vs. 46.6%,P＜0.01）明显低于后者。组1A的DKA诱因主要是感染（33.7%）、中断胰岛素注射（21.3%）、饮食异常（20.2%）,1例患者为胰岛干细胞移植后DKA。组1B仍以感染为主要诱因（4/10）,1例患者因为胰岛素泵故障而发生DKA（1/10）。不同病程内发生的DKA诱因分布不同（P＜0.01）,1年内主要以中断胰岛素注射为主,占39.3%（11/28）;1年以上中断胰岛素注射仅占13.1%（8/61）,主要以感染（22/61）和饮食异常（16/61）为诱因。DKA发生率高的医院主要是以感染为诱因,达50%（12/24）,而DKA发生率低的医院感染诱因占28.1%（18/64）（P＜0.01）。结论 已确诊T1DM患者病程中DKA发生率为5.3%,各中心不同,最高达24.1%。DKA者的血糖控制水平差,不能规律的进行自我血糖监测及门诊复诊,应该强化糖尿病教育。胰岛素泵使用者及胰岛干细胞移植的患者成为新的教育关注点。DKA发生率高的医院需要强化患者学习感染时的处理措施。     

儿童 1型糖尿病 30年临床特征及随访观察

目的 分析儿童1型糖尿病（T1DM）的临床特征,探讨该病对儿童生长发育的影响程度及后期并发症发生的情况。方法 对发病年龄在13个月至14．7岁,经实验室检查确诊为T1DM的210例患儿的临床特征进行了回顾性分性,并对99例患儿进行了1～24年的并发症、生长发育、死因随访。结果 因单纯糖尿病人院者47例（22．4％）;伴酮血症入院者69例（32．9％）;伴酮症酸中毒入院者94例（44．7％）,其中农村患儿78例。起病时有诱因者43例,其中自停胰岛素15例。酮症酸中毒患儿住院时间明显比单纯糖尿病患儿长（P〈0．05）。随访的99例中出现各种并发症50例,其中以微血管病变发生率最高。病程长易并发各种并发症（P〈0．05）,病后的监测方法与并发症的发生也明显相关。患儿组身高明显低于对照组（P〈0．05）。结论 酮症酸中毒是儿童糖尿病的基本特征;病程长易并发各种并发症;加强对儿童糖尿病患者的血糖检测和病后教育,将对儿童糖尿病的治疗起重要作用。     

The changing presentation of children with newly diagnosed type 1 diabetes mellitus

Abstract: Although it is known that the incidence of type 1 diabetes mellitus (DM) in childhood is progressively increasing, it is less clear whether the presentation of newly diagnosed DM is changing. The aim of this study was to establish whether any biochemical or clinical presentation parameters have altered over time.
A retrospective study was performed comparing newly diagnosed children with DM in two 24 month time intervals, 8 yrs apart (1988–89 and 1995–96). Fifty-seven children were diagnosed with type 1 DM in 1988–89 and 70 children in 1995–96. At presentation, children born in the later cohort had a higher pH (p < 0.001) and lower serum glucose (p < 0.05). Although the frequency of diabetic ketoacidosis (DKA) was higher in the 1988/89 cohort (63% vs. 42% in 1995/96) the absolute number of children with DKA in each time interval was similar (33 subjects in 1988–89 vs. 30 subjects in 1995/96). Islet cell antibody (ICA) levels were very different between the two cohorts; higher antibody levels were found in the 1988/89 group (p < 0.01). DKA was also associated with higher ICA titres (p < 0.05). Hospital admission stay decreased from 6.5 DS to 3.4 DS over the 8-year period (p < 0.0001).
At our institution, the presentation of children with type 1 D M is changing with many more children diagnosed before developing DKA. We speculate that a new environmental factor(s) may be responsible for the absolute increase in patients presenting without DKA, while older etiologies (both genetic and environmental) are responsible for the steady, unchanging number of patients with a more severe presentation. Greater awareness of diabetes in children is not the factor contributing to earlier diagnosis before DKA develops.     

Diabetic autoimmunity in infants and pre-schoolers with type 1 diabetes

The incidence of type 1 diabetes is increasing most rapidly in children under 5 yrs of age, a group where the disease appears to be more accelerated than traditional type 1 diabetes. Little is known about demographics, and markers of diabetes autoimmunity, in infants and pre-schoolers with type 1 diabetes. We report an analysis of 47 children diagnosed with type 1 diabetes prior to 5 yrs of age compared with a representative cohort (n=49) diagnosed after 5 yrs of age, and all were followed at Loma Linda University (LLU) Children's Hospital. Ethnic, familial, seasonal, and autoimmune marker characteristics are outlined. To determine the prevalence of diabetes autoimmune markers, ICA512, GAD65 and insulin autoantibodies (IAA) antibodies were measured. Children with early-onset diabetes had a significantly higher incidence of viral illness symptoms (p=0.005) and diabetic ketoacidosis (DKA; p=0.017) at the time of diagnosis. However, hemoglobin A1C (HbA1c) levels at diagnosis were significantly higher in the later-onset group (p=0.001). A honeymoon period was reported in 14.8% of children diagnosed before 5 yrs of age compared with 42.1% in those diagnosed over 5 yrs of age (p=0.038). Islet-cell antibodies (ICAs) and glutamic acid decarboxylase (GAD) antibody titers were significantly different between early- and later-onset groups. ICA titers were positive in 35.29%, and GAD in 41.38% of the early-onset group versus 70.83 and 71.74% in children with later-onset disease, (p=0.001 and 0.009, respectively). IAA titers, drawn after instituting insulin therapy, were not significantly different between the two groups. GAD and ICA512 antibody results suggest a relative lack of diabetes immune markers in infants and toddlers with new-onset diabetes. This finding, and the apparent shorter pre-clinical phase reflected in the lower HbA1c values, may indicate age-related differences in type 1 diabetes autoimmunity or the existence of non-autoimmune diabetogenic mechanisms in younger children.     

Ketoacidosis at onset of type 1 diabetes mellitus in children--frequency and clinical presentation

Abstract: Background: Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden‐Wuerttemberg (BW), Germany. Aim: Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children. Methods: All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose > 250 mg/dL, pH < 7.30 or bicarbonate < 15 mmol/L and ketonuria. Statistical analysis was done after logarithmic transformation. Results: 26.3% (n = 558) of all patients presented with DKA. The mean age of these patients was 7.9 yr. The frequency of DKA is higher in girls than in boys (28.9 vs. 23.8%; p = 0.0079). Those aged 0–4 yr suffered most frequently (p < 0.0001) from ketoacidosis (36.0%). The percentage of DKA in newly diagnosed cases was constant over 10 yr. 23.3% of all patients with DKA presented with an altered level of consciousness; 10.9% of these had clinical signs of coma. No deaths occurred. The proportion of ketoacidosis does not increase concurrently with the number of diabetes manifestations in winter. Conclusion: The proportion of DKA in children with newly diagnosed diabetes mellitus is significant. In particular, children < 5 yr and girls face an increased risk. DKA may be the result of a particularly aggressive subtype of diabetes.     

Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics

Abdul‐Rasoul M, Al‐Mahdi M, Al‐Qattan H, Al‐Tarkait N, Alkhouly M, Al‐Safi R, Al‐Shawaf F, Mahmoud H. Ketoacidosis at presentation of type 1 diabetes in children in Kuwait: frequency and clinical characteristics. Background: Diabetic ketoacidosis (DKA) has significant morbidity and mortality, and is common at diagnosis in children. Objective: Describe the frequency and severity of DKA at diagnosis of type 1 diabetes mellitus (T1DM) in children in Kuwait. Methods: Hospital records of 677 diabetic children less than 12 yr of age, diagnosed during the period of 2000–2006 were reviewed. DKA was defined as blood glucose > 11 mmol/L, pH < 7.3, and/or bicarbonate < 15 mmol/L with ketonuria. Results: Of all patients diagnosed with T1DM, 255 (37.7%) presented with DKA. The frequency of DKA was constant between 2000 and 2002 (42.7–41.5%), but decreased in the following years to 30.7% in 2006 (p < 0.005). The majority had either mild or moderate DKA (74.1%). Fifty‐one (36.7%) of all children in the 0–4 yr had severe DKA compared to ten (2.9%) in the 5‐ to 8‐yr‐old group, and three (1.5%) in 9‐ to 12‐yr‐old patients (p < 0.0001). Moreover, 83% of children with severe DKA were in the 0–4 yr age group. One child (0.15%) died and twenty‐seven (4%) needed intensive care unit (ICU) care. Conclusion: Our study provides recent data on Middle Eastern population, for whom data are sparse. Although it has significantly decreased, the frequency of DKA at presentation of T1DM in children in Kuwait is still high, secondary to the high prevalence of diabetes in the community. Young children, especially those less than 2 yr old remain at high risk. Increasing the general awareness of the public as well as of pediatricians to the disease may lead to early diagnosis before the development of acidosis.     

Clinical features at the onset of childhood type 1 diabetes mellitus in Shenyang,China

Aim: To describe the clinical picture and laboratory features of Chinese children with newly diagnosed type 1 diabetes mellitus. Methods: The clinical and laboratory data of a total of 203 children who presented with newly diagnosed type 1 diabetes mellitus during a 5‐year period (2004–2008) were retrospectively analysed based on hospital records. Results: There were 88 boys (43.3%) and 115 girls (56.7%) with a median age of 8.3 years. The age distribution was categorised as 0–4 years: 52 (25.6%), 5–9 years: 57 (28.1%) and 10–14 years: 94 (46.3%). We found a peak incidence rate in the older age group. No significant seasonality was observed. The most common symptoms were polydipsia, polyuria and weight loss. Eighty‐five (41.9%) of all patients presented with diabetic ketoacidosis (DKA). The average duration of presenting symptoms before the hospital encounter was 24.5 days. Young age group children had shorter duration (17.1 days, P= 0.03) and significantly lower levels of C‐peptide (P= 0.003) and haemoglobin A1c (P= 0.049) than the other groups. Children with DKA had a higher incidence of preceding infections (P= 0.032), lower free triiodothyronine and free thyroxine levels (P= 0.035, 0.046), and higher white blood cell counts (P= 0.000) than the non‐DKA group. Conclusion: The duration between the onset of the symptoms and diagnosis was long, and the proportion of DKA in children with newly diagnosed diabetes mellitus was high. These findings call for a collaborative effort for the early recognition of symptoms by patients and physicians in order to avoid more severe types of presentation.     

25-羟维生素D与儿童1型糖尿病及酮症酸中毒的相关性研究

目的探讨血清25-羟维生素D[25-(OH)D]水平与儿童1型糖尿病(T1DM)及酮症酸中毒(DKA)的相关性。方法选取2006年1月—2009年12月期间152例住院患儿,其中52例为首次发病的T1DM患儿,包括酮症酸中毒(DKA组)21例,以及非酮症酸中毒(非DKA组)31例,其余100例为非T1DM组。检测并比较三组患儿的血清25-(OH)D水平,分析血清25-(OH)D水平与儿童T1DM及DKA的相关性。结果 DKA组患儿的血清25-(OH)D平均为(53.6±27.8)nmol/L,显著低于非DKA组的(69.7±27.9)nmol/L和非T1DM组的(81.8±28.3)nmol/L(P<0.05);非DKA组患儿的血清25-(OH)D水平显著低于非T1DM组(P<0.05)。结论 T1DM患儿的血清25-(OH)D水平低,尤以DKA患儿最为明显,维生素D在儿童T1DM发病中的潜在保护效应值得关注。     

Delayed diagnosis in type 1 diabetes mellitus

Children with suspected type 1 diabetes mellitus (T1DM) should have same day referral to a paediatric diabetes team. 99 children (54 male; median age 10.5 years, range 0.9-15.9 years) were diagnosed with T1DM at our hospital between January 2004 and June 2007. 27 (27.2%) presented in diabetic ketoacidosis (DKA). 37 (37.3%) required hospital admission, while the rest had ambulatory management. In 21 (21.2%) children, diagnosis was delayed >24 h (median 3.0 days, range 1-14 days) due to missed diagnosis at the local hospital (four) or by the general practitioner (seven), arranging a fasting blood glucose test (nine) and outpatient appointment requested via fax (one). Children with delayed diagnosis presented more frequently in DKA (52.3% vs 20.5%, p<0.01), with a higher median presenting HbA1c (12.3% vs 10.9%, p<0.05). There were no differences in age and sex between the delayed diagnosis and immediate referral groups. Healthcare providers need to be aware of the importance of immediate referral of children newly diagnosed with T1DM.