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。

Follow-up study on children with type 1 diabetes mellitus

Objective To analyze the clinical characteristics of type 1 diabetes mellitus(T1DM) in children and explore its late complications and influence growth and development.Methods 210 children with T1DM aged from 13 months to 14.7 years from Feb 1974 to Jun 2004 were reviewed retrospectively.Follow_up survey was performed on 99 of 210 children for 1 to 24 years to evaluate morbidity,complications and influence on children's growth and development.Results Of 210 patients,47(22.4%)were diagnosed as diabetes mellitus(DM),69(32.9%)as diabetic ketonemia(DK)and 94(44.37%) as diabetic ketoacidosis(DKA).There were 43 patients with inducement factors, among them 15 cases were due to withdrawal of insulin.Hospital stay of in_patients with DKA in cluding 78 cases come from rural areas was significantly longer than that with DM(P<0.05).Of 99 follow_up patients,50 showed various complications,of which microangiopathy was the most common one.Complications were easily occurred in patients with longer than in those with shorter duration of disease(P<0.05).DM had adverse effects on children's growth and development.Conclusions DKA is the main complication of T1DM in children.Blood glucose monitoring and education will be important for the treatment of DM in children.