初发1型糖尿病患儿血脂水平观察及其影响因素分析

目的　分析初发1型糖尿病 （T1DM） 患儿的血脂状态，并对其影响因素进行研究。方法　将 2012-01-01—2017-12-31于中国医科大学附属盛京医院新确诊的 348 例 T1DM 患儿临床资料进行收集和汇总，比较T1DM 患儿与 40 例对照组儿童的血脂差异。对 T1DM 患儿根据血脂水平分为血脂正常组（n＝153）与血脂异常组（n＝195），比较两组患儿血脂各项指标差异。根据 糖化血红蛋白（HbA1c）值分为＜11.5%（n＝116）、11.5%～13.5%（n＝109）、＞13.5%（n＝123）3组，比较3组患儿间的血脂差异等。结果　（1）T1DM 患儿的总胆 固醇（ TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、载脂蛋白B（ApoB）等显著高于对照组，而高密度脂蛋白（ HDL）、载脂蛋白A1（ApoA1）显著低于对照组。结果为 TC（mmol/L）（4.29±1.07 vs. 3.85±0.67，P＜0.05）、 TG（mmol/L）（1.29±1.40 vs. 0.82±0.50，P＜0.01）、LDL（mmol/L）（2.61±0.91 vs. 2.17±0.57，P＜0.01）等。（2）T1DM 患儿血脂异常发生率为 56.03%，血脂异常组患儿 HbA1c （%）显著高于血脂正常组（12.93±2.16 vs. 12.10±2.37，P＜0.01）。（3）HbA1c 越大的患儿其 TC、TG、LDL等越高。结果为 TC（mmol/L）（3.96±0.78 vs. 4.12±0.94 vs. 4.75±1.25，P＜0.01）、TG（mmol/L）（0.91±0.50 vs. 1.38±1.72 vs. 1.56±1.60，P＜0.01）、LDL（mmol/L）（2.34±0.72 vs. 2.38±0.73 vs. 3.05±1.03，P＜0.01）。结论　T1DM患儿的血脂异常发病率较正常儿童明显增高；血糖越高的患儿其血脂异常状态越明显。

Analysis of blood lipids and its influencing factors in children with recent-onset type 1 diabetes

Objective　To analyze the blood lipid status of newly diagnosed T1DM children and to study its influencing factors. Methods　The clinical data were collected from 348 patients with recent onset type 1 diabetes who were treated between Jan.1，2012 and Dec.31，2017 in our hospital，and the differences in serum lipids between T1DM children and 40 controls were compared. Children with T1DM were divided into two groups according to their blood lipids level：normal blood lipid group（n＝153） and dyslipidemia group（n＝195），the differences in blood lipid between the two groups of children were compared. According to the level of HbA1c，the children were divided into three groups：HbA1c＜11.5%（n＝116），11.5%-13.5%（n＝109） and HbA1c＞13.5%（n＝123），the differences in blood lipid among the three groups were compared. Results　1. TC，TG，LDL and ApoB were significantly higher in children with T1DM than those in the control group，while HDL and ApoA1 were significantly lower. The results were：TC（mmol/L）（4.29±1.07 vs. 3.85±0.67，P＜0.05），TG（mmol/L）（1.29±1.40 vs. 0.82±0.50，P＜0.01），LDL（2.61±0.91 vs. 2.17±0.57，P＜0.01），etc. 2. The incidence of dyslipidemia in children with T1DM was 56.03%，HbA1c（%） was significantly higher in the dyslipidemia group than in the normal lipid group（12.93±2.16 vs. 12.10±2.37，P＜0.01）. 3. The patients with larger HbA1c had significantly higher TC，TG and LDL. The results were：TC（mmol/L）（3.96±0.78 vs. 4.12±0.94 vs. 4.75±1.25，P＜0.01），TG（mmol/L）（0.91±0.50 vs. 1.38±1.72 vs. 1.56±1.60，P＜0.01），LDL（mmol/L）（2.34±0.72 vs. 2.38±0.73 vs. 3.05±1.03，P＜0.01），etc. Conclusions　The incidence of dyslipidemia is significantly higher in children with T1DM than in normal children. The higher the blood glucose level，the more severe the dyslipidemia.