摘要
目的探讨暴发性l型糖尿病（FT1DM）的临床表现、诱因、治疗及疾病转归。方法对2012年1月至2018年3月北京协和医院内分泌科收治的FT1DM患者进行临床资料收集和分析，并总结其临床特点。结果22例FT1DM患者中，男性10例，女性12例，中位发病年龄为31岁，中位病程为3d，超过半数的患者病初有流感样症状或消化道症状，多数伴血浆胰酶升高。20例患者起病时糖尿病自身抗体阴性，2例起病时谷氨酸脱羧酶抗体阳性，4例伴抗甲状腺抗体及抗核抗体等自身抗体阳性。1例患者发病前感染风疹病毒，3例有药物超敏反应综合征病史，3例与妊娠相关。所有患者均予外源性胰岛素制剂治疗，其中5例患者同时有血糖波动大，夜间低血糖的临床特点，且胰岛素自身抗体阳性，考虑外源性胰岛素抗体综合征（EIAS）可能性大。结论FT1DM进展迅速，病程凶险，患者需终身外源性胰岛素制剂治疗。治疗中出现无法解释的高血糖与频繁低血糖交替时，需警惕E1AS的可能。
Objective To explore the clinical features, treatment and prognosis of iuhninant type 1 diabetes mellitus （FT1DM）. Methods Patients admitted in Peking Union Medical College Hospital from January 2012 to March 2018 with the diagnose of FT1DM were enrolled in the study. All the clinical data were collected and analyzed. Results A total of 22 patients were enrolled with 10 males and 12 females. The median age was 31 years old and the median duration of the disease onset was 3 days. Cold-like symptoms and gastrointestinal symptoms with elevated pancreatic enzymes right before the onset were observed in more than half of the patients. Islet-related autoantibodies were negative in 20 patients, while glutamate decarboxylase antibody was positive in 2 patients and 4 patients were found to be positive for autoantibodies other than islet-related autoantibodies. Rubella virus infection was confirmed in 1 case, while FTIDM manifested in 3 cases soon after drug hypersensitivity syndrome （DIHS） and 3 cases happened during pregnancy. All patients were treated with insulin preparations, of which 5 patients manifested as robust blood glucose fluctuations and frequent hypoglycemia at night. Insulin autoantibodies was found to be positive in the above 5 patients, thus the diagnose of EIAS was probable. Conclusion FT1DM has remarkably abrupt onset and could be lethal. Lifelong injection of insulin preparations is necessary. When encountered with unexplained blood glucose fuctuations, the possibility of EIAS should be considered.
作者
吴晗
方兴宇
于淼
肖诚
邓明群
付俊玲
肖新华
Wu Han;Fang Xingyu;Yu Miao;Xiao Cheng;Deng Mingqua;Fu Junling;Xiao Xinhua(Department of Endocrinology,Key Laboratory of Endocrinology,Ministry of Health,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing 100730,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2018年第9期590-595,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
中国医学科学院医学与健康科技创新工程基金（CIFMS2017-12M-1.008）
北京协和医院巾青年科研基金（PUMCH-2016-1.14）
关键词
糖尿病
糖尿病
暴发性
1型
胰岛素抗体
Diabetes mellitus
Diabetes mellitus
fulminant
type 1
Insulin antibody
