儿童1型糖尿病不同病期胰岛素用量相关调节参数的探讨

目的观察儿童1型糖尿病(1型DM)不同病期的胰岛素用量及其与代谢和胰岛β 细胞功能之间的相关关系。 方法山东省立医院儿科于1998年10月至2004年12月，连续观察就诊的35例1型DM患儿急性代谢紊乱期(急性期)、暂时缓解期(蜜月期)及强化期空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)、空腹C肽/FBG(C肽/FBG)及胰岛素(INS)用量，并计算各期胰岛素敏感指数(ISF)。比较上述指标在三期间的差异并与33例健康儿童(对照组)对比前4项指标的差异；观察急性期患儿进入蜜月期的百分率。观察胰岛素用量与C肽/FBG之间的直线相关关系。 结果(1)FBG、2hPBG、HbA1c在不同病期之间差异均有显著性意义，从高到低依次为急性期、强化期、蜜月期;蜜月期FBG、2hPBG与对照组比较差异无显著性意义；C肽/FBG在急性期与强化期比较及蜜月期与对照组比较时差异均无显著性意义，其余各组之间比较差异均有显著性意义；INS用量在不同病期之间比较差异均有显著性意义，从高到低依次为急性期、强化期及蜜月期；ISF在急性期与强化期比较差异无显著性意义，二者与蜜月期比较差异均有显著性意义。急性期患儿657%进入蜜月期。(2)INS用量与C肽/FBG之间呈现显著性直线负相关(r=-091,P<0001)，回归方程:每天INS用量=106-177×(C肽/FBG)。 结论对1型DM儿童可依据糖代谢指标的变化调整胰岛素的用量，其中，C肽/FBG作为INS用量调整的参考依据最准确，可根据二者之间的回归方程由C肽/FBG粗略计算胰岛素用量，并根据餐前血糖及胰岛素敏感指数对胰岛素用量进行调整。

Study on insulin dosage adjustment and related indexes in different period of type 1 diabetes mellitus in children.

AbstractObjectiveTo study the insulin dosage and the metabolic indexes,β cell function of islets of pancreas in different period of type 1 diabetes mellitus and the correlation. MethodsFrom Oct.1998 to Dec.2004,thirty five newly diagnosed patients with type 1 diabetes mellitus(T1DM) during acute metabolic disturbance period(acute period)，the temporary remission period(honeymoon period) and reinforcement period were included in this study.Calculate ISF in different stage.Compare the difference among the mentioned indexes above,and compare the former four indexes with those of thirty three healthy children.Percentage of patients from acute period to honeymoon period was calculated.Linear correlation analysis was made between C peptide/FBG and insulin dosage. ResultsFBG and 2hPBG were significantly different in different periods,one by one from the highest to the lowest being acute、reinforcement and honeymoon period.There was no significant difference between T1DM group during honeymoon period and control group about FBG and 2hPBG.There was no significant difference between acute and reinforcement period about C peptide/FBG,and between honeymoon period and control group.There was significant difference between any two of others about C peptide/FBG.Insulin dosage was significantly different in different period,the sequence of them from the highest to the lowest being acute,reinforcement and honeymoon period.ISF was significantly different between acute and honeymoon,honeymoon and reinforcement period,but no significant difference between acute and reinforcement period.There were 657% of acute peri od patients entering honeymoon period.There was a significant negative linear correlation between insulin dosage and C peptide/FBG(r=-091,P<0001).The regression equation：insulin dosage［U/(kg·d)=106-177×(C peptide/FBG)］. ConclusionMetabolic indexes are significantly different in different period of T1DM in children；particularly,insulin dosage can be calculated from C peptide/FBG by the regression equation of them and can be adjusted according to FBG and ISF.