102例酮症倾向2型糖尿病患者的临床特征分析

目的探讨酮症倾向2型糖尿病的临床特征及治疗方法。方法102例酮症倾向2型糖尿病在胰岛素降糖治疗1个月后，停用胰岛素给予口服降糖药单用或联合治疗，接受至少1年的随访。根据最终的治疗方案，分为口服降糖药（OHA）组和胰岛素治疗（INS）组。结果（1）经过1年的随访，77．5％的患者通过口服药物可将血糖得到较满意的控制，22．5％的患者因严重高血糖或酮症需要再次接受胰岛素治疗。（2）酮症倾向的2型糖尿病具有普通2型糖尿病许多类似的临床特点和病理生理特征。（3）与INS组相比，OHA组起病时的血糖、HbA1c、胰岛素强化治疗达标时间、男性构成比较低，而BMI、甘油三酯、糖尿病家族史构成比较高（P〈0．05）。（4）在高血糖得到控制后，OHA组胰岛素分泌指数（MBCI）和MBCI的变化值均大于INS组（P〈0．05）。（5）多元回归分析发现，高血糖控制后的MBCI、：BMI为选择不同治疗方案（口服药治疗或胰岛素治疗）的主要参考因素。结论酮症倾向2型糖尿病可能是2型糖尿病的一个亚型。在短期胰岛素治疗后，大多数可以改用口服降糖药，高血糖控制后的MBCI、：BMI将有助于不同降糖方案的选择。

Analysis of clinical characteristics of ketosis-prone type 2 diabetes

Objective To investigate the clinical characteristics and therapy of ketosis-prone type 2 diabetes. Methods A total of 102 patients with ketosis-prone type.2 diabetes who had insulin therapy for one month were treated with oral hyperglycemia agents after discontinued insulin therapy. Subjects were then followed at less one year,who were divided into oral hypoglycemic agents（ OHA ）group and insulin（INS）group according to final treatment protocols. Rsults （ 1 ） At one year,77.5% patients achieved near-normoglycemic remission with oral hyperglycemia agents,22. 5% patients relapsed into serious hyperglycemia or diabetic ketedosis needing insulin therapy again. （2） The patients with ketesis-prone type 2 diabetes had much similarities of clinical and pathophysiological characteristics to common type 2 diabetes mellitus. （3）The OHA group showed lower the values of blood glucose and HbA1c at diagnose,the time for blood glucose to be targeted in intensive insulin therapy,male proportion,whereas,lfigher body mass index,the levels of triglyceride as well as the proportion of family history of diabetes as compared with the INS group（P 〈0.05）. （4）There were higher levels of marker of insulin secretion（ MBCI）and the increment of MBCI in OHA group than in INS group after glucose lowering（P 〈0.05）. （5）Muhiple regression analysis showed that affect different treatment protocols（oral hypoglycemic agents or insulin protocol）were MBCI,BMI after glucose lowering. Conclusion Ketosis-prone type 2 diabetes may be a subtype of type 2 diabetes. The treatment of ketosis-prone type 2 diabetes could turn back to oral agents due to restoration of beta-cell function after insulin treatment in a short time. MBCI and BMI after glucose lowering may be helpful to select different antiglycemia protocols.