摘要
目的分析儿童系统性红斑狼疮(JSLE)合并糖尿病(DM)的临床特征并文献复习。方法收集首都儿科研究所附属儿童医院2002至2008年收治的4例JSLE合并DM患儿的临床资料,总结其临床表现、治疗和预后。结果4例女性患儿,3例12岁,1例8岁。4例患儿风湿免疫病相关自身抗体阳性,均确诊为JSLE;4例患儿多次查血糖升高,符合DM诊断;2/4例行胰岛素刺激试验和糖耐量试验,1例提示1型糖尿病可能性大,1例2型糖尿病可能性大;3/4例DM发病急剧,出现DM酮症酸中毒的临床表现。2例确诊为甲状腺功能减低。4例患儿均予糖皮质激素或添加免疫抑制剂治疗,狼疮活动均能缓解。1例患儿失访;3例患儿分别随访1、2和5年,其中2例长期应用胰岛素治疗,1例JSLE活动期予胰岛素治疗,病情稳定后通过控制饮食维持血糖正常;血糖均控制满意,生长发育正常。结论DM可能是JSLE的一种表现。糖皮质激素可能不是引起DM的主要原因。在治疗JSLE合并DM时,糖皮质激素是主要的治疗药物。JSLE患儿应及早预防DM的发生,除监测血糖和尿糖外,还应检测胰岛素自身抗体和谷氨酸脱羧酶抗体。
Objective To explore the the clinical relationship between juvenile systemic lupus erythromatus （JSLE）and diabetes mellitus （DM）. Methods The clinical data of four JSLE patients accompanied with DM diagnosed from 2002 to 2008 were collected to summarize clinical features, treatment and prognosis. Results All 4 patients were girls, 3 of them were 12 years old,the other was 8 years old. All the patients were diagnosed JSLE and DM. Two patients were taken insulin stimulation test and glucose tolerance test. One patient had the possibility of T1DM and one patient had the possibility of T2DM. Three onsets were sudden and the patients presented with diabetic ketoacidosis sequently. One patient was accompanied with DM during the processing of the disease, in the other two cases DM occurred after 1 and 3 years treatment respectively. Two patients were also accompanied with thyroid impairment. All 4 patients could be relieved, and after the treatment of DM, the level of blood glucose was steady. In 3 patients with the complication of DM, their growth and development were normal. Conclusions DM may be one of the manifestations of JSLE. Corticosteroid was not the main cause of JSLE complicated with DM. Corticosteroid was the major medicine to treat JSLE accompanied with DM. The immune suppressive drugs could reduce the incidence of elevated blood glucose which was the side effect of eorticosteroids. The patients with JSLE should be against the DM preventively. Not only the levels of blood glucose and urine, but also the insulin autoantibody and glutamic acid deearboxylase antibody should be detected in JSLE patients.
出处
《中国循证儿科杂志》
CSCD
2010年第1期51-54,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
儿童系统性红斑狼疮
糖尿病
酮症酸中毒
糖皮质激素
儿童
Juvenile systemic lupus erythematosus
Diabetes mellitus
Ketoacidosis
Corticosteroid
Child
