成年起病的1型糖尿病临床分析

目的 分析成年起病的1型糖尿病（T1DM）的临床特点.方法 回顾性分析1986年1月至2012年2月在解放军总医院住院治疗的所有516例成年起病T1DM患者的临床资料.新诊断（病程≤3个月）患者则根据是否伴有酮症酸中毒（DKA）和是否有糖尿病家族史分组,比较组间的临床和生化特点；已诊断患者根据是否伴有糖尿病家族史和不同病程（1～5年、6～10年、11 ～ 15年和≥16年）,分别比较组间的代谢控制以及慢性并发症发生情况.计量资料符合正态分布且方差齐者采用最小有意义差异t检验.结果 516例成年起病者中新诊断133例,已诊断383例,发病年龄（29±8）岁,住院年龄（37±11）岁,体质指数（BMI）为（20.8 ±3.3）kg/m2,99例（19.2％）患者有糖尿病家族史.133例新诊断患者中,以DKA起病者55例（41.4％）.与非DKA起病组相比,DKA起病组空腹血糖、血清尿酸水平更高（t=4.019、2.288,均P＜0.05）.新诊断患者和已诊断患者中分别有29例（21.8％）和70例（18.3％）有糖尿病家族史.在已诊断患者中,与无家族史组相比,有家族史者血清甘油三酯更高（t=1.263,P＜0.05）,慢性肾功能不全、背景期视网膜病变和高血压发生率更高（x2=16.029、5.843、10.164,P＜0.05）,高血压发生更早（t=2.769,P＜0.05）.病程为1～5年、6～10年、11～15年和≥16年患者BMI、尿酸、总胆固醇、糖化血红蛋白差异均有统计学意义（H=29.282、16.590、12.530、50.590,均P＜0.05）.临床肾病、慢性肾功能不全、视网膜病变以及自主神经病变的发生率在发病11 ～ 15年时达发病高峰.结论 成年起病的T1DM患者具有独特临床特点,其慢性并发症及合并症的发生率与糖尿病家族史有关,微血管并发症在发病11～15年时达发病高峰.

Clinical analysis of adult-onset type 1 diabetes mellitus

Objective To analyze the clinical characteristics of adult-onset type 1 diabetic patients （T1DM）.Methods All hospitalized cases of adult-onset T1DM patients in the Department of Endocrinology of Chinese PLA General Hospital from January 1986 to February 2012 were retrospectively analyzed.All the patients were divided into two groups,newly-diagnosed and non-newly-diagnosed group,according to the cut point of 3 months.Newly-diagnosed group were further divided into groups depending on whether the patient was accompanied with ketoacidosis （DKA） or family history of diabetes,and the clinical characteristics were compared between groups.The non-newly-diagnosed patients were divided into 4 groups according to different course of disease： 1-5,6-10,1 1-15 and ≥ 16 years.Differences in measurement data were compared with least significant difference t test when the data obeyed normal distribution with homogeneity in variance.Results Total of 516 cases of adult-onset T1DM patients accounted for 69.5％ of all T1DM at the same period,and 133 cases were newly-diagnosed patients,while 383 were not.The average age of onset was （29 ± 8） years.The patients were hospitalized at the age of （37 ± l 1） years with a mean body mass index（BMI） of （20.8 ±3.3） kg/m2,19.2％ （99/516） of the patients had a family history of diabetes.Fifty-five cases（41.4％） of newly-diagnosed patients were associated with DKA and 29 cases （21.8％） had a family history of diabetes; fasting blood glucose and blood uric acid in patients associated with DKA was significantly higher than those in patients without DKA （t =4.019,2.288,both P ＜ 0.05）.Seventy cases（18.3％） of non-newly-diagnosed patients had a family history of diabetes.In the non-newlydiagnosed group,compared with those in the patients without family history of diabetes,the triglyceride level （t =1.263,P ＜ 0.05） was higher and incidence of hypertension,chronic renal failure and non-proliferative diabetic retinopathy were higher in patients with a family history （x2 =16.029,5.843,10.164,all P ＜0.05） ; and high blood pressure also occurred earlier in patients with a family history （t =2.769,P ＜0.05）.The BMI,uric acid,total cholesterol,glycated hemoglobin Alc was different significantly in patients with different duration of disease （H =29.282,16.590,12.530,50.590,all P ＜ 0.05）.The incidence of clinical nephropathy,chronic renal insufficiency,retinopathy and autonomic neuropathy reached apex in patients with disease duration of 11-15 years.Conclusion Adult-onset T1 DM has unique clinical features,and its chronic complications and the incidence of complications related with family history of diabetes,the incidence of microvascular complications reaches peak in patients with disease duration of 11-15 years.