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］

A 10-year review of childhood type 1 diabetes mellitus and the clinical value of interleukin-10 in diabetic ketoacidosis

Objective To review the incident status of childhood type 1 diabetes mellitus hospitalized in the Children′s Hospital of Zhejiang University School of Medicine from 1999 to 2009 and to explore the clinical value of IL-10 in diabetic ketoacidosis.Methods The clinical data of 263 children with type 1 diabetes mellitus hospitalized in the Children′s Hospital of Zhejiang University School of Medicine from January 1999 to February 2009 were retrospectively reviewed.Serum lipid levels were measured in 48 children with type 1 diabetes mellitus and in 24 healthy children.The diabetic children were classified into two subgroups,with or without ketoacidosis.Serum lipid and cytokines levels were compared.Results Childhood type 1 diabetes mellitus was common in females(56.3%).The peak incident age of the disease was between 6 and 11.9 years.Diabetic ketoacidosis was as the presenting symptom for the first visit in 86 cases(32.7%).The levels of serum lipid,blood glucose and HbA1c in diabetic children with ketoacidosis were significantly higher than those without ketoacidosis(P<0.05).Logistic analysis demonstrated that the increased levels of blood glucose,serum lipid and HbA1c were risk factors for diabetic ketoacidosis.The level of serum IL-10 in diabetic children with ketoacidosis was significantly higher than that in patients without ketoacidosis(P<0.01),while there were no differences in serum levels IL-2,IL4,IL-6,TNF-α and IFN-γ between them.Serum levels IL-2,IL-4,IL-6,IL-10,TNF-α and IFN-γ in diabetic children were significantly higher than those in healthy children(P<0.01).Conclusions Ketoacidosis is a common acute complication of type 1 diabetes mellitus.The disorders of glucose and lipid metabolism are the risk factors for ketoacidosis in diabetic children.IL-10 may be a sensitive index of diabetic ketoacidosis in children with type 1 diabetes mellitus.