發(fā)布時間：2018-03-31 13:29

  本文選題：暴發(fā)性　切入點(diǎn)：1型糖尿病臨床特點(diǎn)　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：探討中國暴發(fā)性1型糖尿病患者的臨床特點(diǎn)。方法：回顧性分析廣西醫(yī)科大學(xué)第九附屬醫(yī)院2003年1月至2014年12月期間以酮癥或酮癥酸中毒起病患者,根據(jù)日本Hanafusa等提出的暴發(fā)性1型糖尿病診斷標(biāo)準(zhǔn)[1],有7例F1D患者,分析我院7例暴發(fā)性1型糖尿病患者臨床特點(diǎn)。同時利用知網(wǎng)、萬方、維普三大中文數(shù)據(jù)庫,通過輸入“暴發(fā)性1型糖尿病”關(guān)鍵詞查閱2005年至2014年我國關(guān)于F1D的文獻(xiàn)報(bào)道。去除重復(fù)、綜述、會議及僅有摘要的文章,剩余111篇文獻(xiàn)。采用日本Hanafusa等[1]提出的暴發(fā)性1型糖尿病診斷標(biāo)準(zhǔn),從111篇病例報(bào)道中納入45例F1D患者,聯(lián)合我院7例F1D患者,分析該52例F1D患者的臨床特征,并與日本、韓國暴發(fā)性1型糖尿病患者的臨床特點(diǎn)進(jìn)行比較。結(jié)果：1、本院收治的7例暴發(fā)性1型糖尿病患者中男性5例,女性2例。均以酮癥酸中毒起病,病程僅1-3天,起病時血糖均大于16.Ommol/L。胰島功能極差,空腹血漿C肽0.1 nmol/L(0.3 ng/ml),且刺激后(餐后或胰高血糖素注射后)血漿C肽0.17 nmol/L(0.5 ng/ml)。起病時均出現(xiàn)了電解質(zhì)代謝紊亂及腎功能衰竭,一些患者還出現(xiàn)了肝酶、肌酶、淀粉酶等酶學(xué)異常。經(jīng)治療后均好轉(zhuǎn)出院,出院后均需胰島素控制血糖,胰島素用量為16-49U/d。2、①中國暴發(fā)性1型糖尿病患者平均發(fā)病年齡為32.2±12.6歲,18歲以上患者約占總數(shù)的96%,而且18-30歲的病例數(shù)最多,約占總數(shù)的52%。②男、女患者臨床特點(diǎn)比較,結(jié)果顯示男性患者起病時血鉀水平高于女性患者,兩組患者發(fā)病年齡、病程、起病時血糖、動脈血PH、血鈉及HbAlc水平比較無統(tǒng)計(jì)學(xué)差異。③妊娠相關(guān)性暴發(fā)性1型糖尿病患者與非妊娠相關(guān)性暴發(fā)性1型糖尿病患者臨床特點(diǎn)比較,兩組患者起病時的血糖、病程、HbAlc水平、動脈血pH、血鈉、血鉀差異無顯著統(tǒng)計(jì)學(xué)意義。④和日本患者相比,我國暴發(fā)性1型糖尿病患者的發(fā)病年齡更低、病程更短、發(fā)病時血糖較低；電解質(zhì)代謝紊亂更嚴(yán)重,表現(xiàn)為高血鉀、低血鈉。⑤與韓國暴發(fā)性1型糖尿病患者相比,我國暴發(fā)性1型糖尿病患者發(fā)病年齡更低,起病時血鉀更高。結(jié)論：①暴發(fā)性1型糖尿病在我國并非罕見,且患者多以成年起病。②妊娠相關(guān)性暴發(fā)性1型糖尿病患者與非妊娠相關(guān)性暴發(fā)性1型糖尿病患者臨床特點(diǎn)相似。③中國暴發(fā)性1型糖尿病患者發(fā)病年齡較日本、韓國患者小,發(fā)病時血鉀更高。
[Abstract]:Objective: to investigate the clinical characteristics of patients with fulminant type 1 diabetes mellitus in China. Methods: the patients with ketoacidosis or ketoacidosis from January 2003 to December 2014 in the Ninth affiliated Hospital of Guangxi Medical University were analyzed retrospectively. According to the diagnostic criteria of fulminant type 1 diabetes put forward by Hanafusa et al in Japan, there were 7 cases of F1D patients. The clinical characteristics of 7 cases of fulminant type 1 diabetes in our hospital were analyzed. The key words of "fulminant type 1 diabetes" were used to review the literature on F1D in China from 2005 to 2014. According to the diagnostic criteria proposed by Hanafusa et al. [1], 45 patients with F1D and 7 patients with F1D in our hospital were included in this study. The clinical features of 52 patients with F1D were analyzed and compared with those in Japan. Results the clinical characteristics of 7 cases of fulminant type 1 diabetes mellitus in South Korea were compared. Results among 7 cases of type 1 diabetes treated in our hospital, 5 cases were male and 2 cases were female. All of them were caused by ketoacidosis and the course of disease was only 1-3 days. The plasma glucose was higher than 16.Ommol / L. the islet function was extremely poor, the fasting plasma C-peptide was 0.1 nmol/L(0.3 / ml / ml, and after stimulation (postprandial or glucagon injection), the plasma C-peptide 0.17 nmol/L(0.5 / ml 路ml. Some patients also showed abnormal enzymes such as liver enzymes, muscle enzymes, amylase, and so on. After treatment, they were all better and discharged from hospital, all of whom needed insulin to control their blood sugar after discharge. The average age of onset of fulminant type 1 diabetes in China was 32.2 鹵12.6 years old or over 18 years old, and the number of patients aged 18-30 years was the most, accounting for 522.2% of the total number of cases. The clinical characteristics of female patients were compared. The results showed that the serum potassium level of male patients was higher than that of female patients. There was no significant difference in blood PH, serum sodium and HbAlc levels. 3 the clinical characteristics of patients with pregnancy-associated fulminant type 1 diabetes mellitus and those with non-pregnancy associated type 1 diabetes mellitus were compared. The blood glucose, course of disease and HbAlc level were compared between the two groups. There was no significant difference in pH, sodium and potassium between arterial blood and Japanese patients. Compared with Japanese patients, the onset age of fulminant type 1 diabetes in China was lower, the course of disease was shorter, the blood glucose was lower and the electrolyte metabolism disorder was more serious. Compared with Korean patients with fulminant type 1 diabetes, the patients with fulminant type 1 diabetes in China have lower onset age and higher serum potassium at the onset of the disease. Conclusion it is not uncommon in China to have 1 type 1 diabetes mellitus. The clinical characteristics of patients with type 1 diabetes associated with pregnancy and non-pregnancy associated type 1 diabetes were similar. 3 the age of onset of type 1 diabetes in China was lower than that in Japan, and that in Korea was younger than that in South Korea. The blood potassium level is higher at the time of onset.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 陳海冰;包玉倩;周健;張鋒;李青;賈偉平;;暴發(fā)性1型糖尿病合并心跳驟停搶救成功一例[J];上海醫(yī)學(xué);2009年02期

2 程杏花;;產(chǎn)后暴發(fā)性1型糖尿病1例[J];實(shí)用婦產(chǎn)科雜志;2011年08期

3 鄭超;王臻;張貽宇;譚愈昱;超晨;周海峰;楊亞玲;車志宏;周智廣;;暴發(fā)性1型糖尿病臨床流行病學(xué)調(diào)查[J];中國糖尿病雜志;2009年09期

4 張弛,周智廣,張冬梅,楊曉琳,周敏,林健,黃干,王建平;急驟起病伴胰酶增高的1型糖尿病臨床和免疫學(xué)特征[J];中華醫(yī)學(xué)雜志;2005年14期

5 楊治芳;湯佳珍;劉建英;昌玉蘭;;妊娠相關(guān)暴發(fā)性1型糖尿病對妊娠結(jié)局影響的觀察[J];中國糖尿病雜志;2012年12期

6 邱俊霖;鐘宇華;梁華晟;曾云先;蘇會璇;;暴發(fā)性1型糖尿病5例臨床資料分析與討論[J];中國糖尿病雜志;2014年06期

，

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