我院10年21例新发儿童Ⅰ型糖尿病临床分析

目的分析我院1999～2009年诊断的Ⅰ型糖尿病（T1DM）患儿临床特征。方法对1999年1月1日至2009年12月30日住院且为首次发病的21例T1DM患儿的年龄、性别、发病季节、血糖、C肽、糖化血红蛋白、血脂等特点进行回顾性分析。把首发患儿与复诊时继发酮症酸中毒（DKA）者再分为DKA与非DKA两组,高血脂与血脂正常组,比较两组血糖、C肽、糖化血红蛋白、总胆固醇、甘油三酯差异。结果 10年间广西新发T1DM总数少,婴幼儿发病更少,学龄期与青春期稍多,平均发病年龄（6.29±3.55）岁;男女发病数相近;首发以冬春为多;首发出现DKA较多,占60.9%,治疗后复发DKA多,26例次。入院血糖（29.52±7.28）mmol/L,糖化血红蛋白HbA1c（13.22±3.92）%,空腹C肽（0.22±0.11）pmol/L,血气分析：pH7.33±0.09、实际碳酸氢根11.00±6.13,全血剩余碱-9.35±4.87,血脂：总胆固醇（3.98±1.07）mmol/L、甘油三酯（1.17±0.58）mmol/L。合并DKA组与非DKA组相比血糖、总胆固醇（P=0.026）,明显升高（P=0.014）,C肽、糖化血红蛋白、三酰甘油差异无统计学意义（P〉0.05）;高血脂与血脂正常组比较,血糖、糖化血红蛋白偏低,三酰甘油（P〈0.05）,C肽、总胆固醇无差异（P〉0.05）。结论初发T1DM患儿总数不多,首发与复发合并DKA比例高。合并DKA血糖明、总胆固醇、显升高。

Clinical analysis of 21 children's cases of new onset of type 1 diabetic in Guangxi in last decade

Objective To analyze the clinical features of the new onset of type 1 diabetic （T1DM） among children patient in Nanning,Guangxi from 1999 to 2009.Methods A retrospective analysis was done to find out the features of 21 children＇s cases of new onset of T1DM according to their age,gender,seasons of onset,glycemia,C peptide,glycosylated hemoglobin （HbAlc）,blood-lipid,etc.The children patients of first onset and secondary diabetic ketoacidosis （DKA） were respectively divided into DKA group and non-DKA group,hyperlipoidemia group and normal lipoid group,and found out the differences of glycemia,C peptide,glycosylated hemoglobin,total cholesterol and triglyceride between two groups.Result Few cases of new T1DM were found in Guangxi in last ten years,and fewer onsets in infants,while more cases were of schooling age and puberty,6.29±3.55 years on average.Incidence was close between the male and female cases;first onset mainly found in winter and spring;majority （60.9%） of first onset were DKA;26 cases were recurrented of DKA.Some tests were conducted at random after their admission,glycemia （29.52±7.28） mmol/L,HbAlc 13.22%±3.92,C peptide （0.22±0.11） pmol/L.blood gas analysis：pH 7.33±0.09,actual bicarbonate radical 11.00±6.13,whole blood base excess-9.35±4.87.Blood-lipid test：total cholesterol （3.98±1.07） mmol/L.triglyceride （1.17±0.58） mmol/L.Glycemia of DKA group was significantly higher than non-DKA group （P=0.014）,total cholesterol （P=0.026）.Compared to non-DKA,C peptide,HbAlc,total cholesterol and triglyceride was greatly higher in DKA group （P0.05）.Glycemia,HbAlc and triglyceride was significantly difference between hyperlipoidemia group and normal lipoid group,while C peptide,total cholesterol was without significantly difference.Conclusion Total number of first onset T1DM children patient is not too large,but with high proportion of combination of first onset and recurrence.Glycemia of the DKA group is apparently higher than that of non-DKA group.While the differences of C peptide,glycosylated hemoglobin,total cholesterol and triglyceride of two groups are not distinct.However,there are statistically significant differences of glycemia,glycosylated hemoglobin and triglyceride between hyperlipoidemia group and normal lipoid group.