小儿新发1型糖尿病酮症酸中毒与小儿应激性高血糖的临床诊断与鉴别

目的 探讨小儿新发1型糖尿病酮症酸中毒与小儿应激性高血糖的临床诊断与鉴别方法.方法 选取2008年6月至2011年6月在我院接受治疗的35例1型糖尿病酮症酸中毒患儿为DKA组；选取同期在我院接受治疗的30例应激性高血糖患儿为SHG组,观察两组生化指标及鉴别情况,并与同期在我院正常体检的30例受检儿童生化指标进行比较分析.结果 DKA组和SHG组即时血糖(RBG)、空腹血糖(FBG)均较对照组有明显升高,组间比较差异有统计学意义(P均＜0.01)；DKA组HbA1c水平显著高于SHG组和对照组,组间比较差异有统计学意义(P＜0.05),而SHG组HbAc水平与对照组相当,组间比较差异无统计学意义(P＞0.05)；DKA患儿均需长期依赖胰岛素治疗才可控制血糖,而SHG组无需长期依赖胰岛素治疗.结论 应激性高血糖和糖尿病酮症酸中毒临床表现均为高血糖(BG)症状,HbA1c和是否长期依赖胰岛素治疗可作为鉴别SHG和DKA的良好指标,值得临床借鉴采用.

Clinical diagnosis and discrimination of children with type 1 diabetes ketoacidosis and children with emerging stress hyperglycemia

Objective To explore the the clinical diagnosis and discrimination of children with type 1 diabetes ketoacidosis and children with emerging stress hyperglycemia.Methods 35 children with type 1 diabetes ketoacidosis treated from June 2008 to June 2011 were enrolled into DKA group;30 children with emerging stress hyperglycemia treated during the same period were enrolled into the SHG group.Biochemical markers and the identification of the two groups were observed,compared and analyzed with 30 children who received normal physical examination(the control group) during the same time.Results RBG and FBG of both DKA and SHG groups were significantly higher than those of the control group,with significant differences(all the P<0.01);HbA1c level of the DKA group was significantly higher than that of the SHG group and the control group,with significant differences(P<0.05),while the SHG group’s HbA1c levels were equivalent to the control group,which showed no significant difference;children in the DKA group needed long-term insulin-dependent treatment to control of blood sugar,while the SHG group did not need long-term treatment of insulin-dependent.Conclusion Clinical manifestations of both SHG and DKA groups are high BG symptoms,HbA1c,and whether needs long-term treatment of insulin-dependent can be good indicators to identify SHG and DKA.