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目的探讨儿童糖尿病(DM)的临床特点,为临床诊治提供理论依据。方法对1999年1月-2009年3月在本院住院的198例DM患儿的临床表现和实验室检查进行回顾性临床分析。结果 198例DM患儿中,男97例,女101例。均为首诊病例;发病高峰年龄为5～6岁及9～11岁;首诊例数逐年增加,2008年较1999年增加了3.7倍;其中1型糖尿病(T1DM)174例(占88.9%),2型糖尿病7例(占3.5%),新生儿DM 14例(占7.1%),其他3例(占1.5%)。首诊的T1DM患者中,酮症酸中毒(DKA)的发生率为42.0%;发病前有感染史者55例,与无感染史者比较,DKA的发生率有统计学差异(P<0.01)。有DM家族遗传史者23例。并甲状腺功能亢进症2例;并暂时性甲状腺功能减低症31例;并肝功能异常30例,肾功能异常12例,血脂异常48例,尿蛋白阳性27例。糖化血红蛋白为(12.0±1.8)%;共分析了25例T1DM患者的自身抗体,胰岛细胞抗体阳性率为28%,胰岛素自身抗体的阳性率为20%,谷氨酸脱羧酶自身抗体(GADA)阳性率为72%。结论首诊的儿童DM逐年增加,以T1DM为主;新生儿DM增加明显;DKA是T1DM患者就诊的重要原因;首诊的T1DM者中,感染是发生DKA的重要诱因;儿童DM常合并暂时性甲状腺功能减低症、肝肾功能异常及血脂异常;糖尿病自身抗体中GADA的阳性率最高。
Objective To investigate the clinical features of children with diabetes mellitus (DM) and provide a theoretical basis for clinical diagnosis and treatment. Methods The clinical manifestations and laboratory tests of 198 DM children hospitalized in our hospital from January 1999 to March 2009 were retrospectively analyzed. Results 198 cases of DM children, 97 males and 101 females. The first case of diagnosis was increased year by year and increased by 3.7 times in 2008 compared with that in 1999. Among them, 174 cases (88.9%) of type 1 diabetes mellitus (T1DM) , 7 cases of type 2 diabetes (3.5%), 14 cases of neonatal DM (7.1%) and 3 cases (1.5%). The first diagnosis of T1DM patients, the incidence of ketoacidosis (DKA) was 42.0%; before onset of infection in 55 cases, with no history of infection, the incidence of DKA was statistically significant (P <0.01) . There are 23 cases of DM family history. And hyperthyroidism in 2 cases; and temporary hypothyroidism in 31 cases; and liver dysfunction in 30 cases, 12 cases of renal dysfunction, dyslipidemia in 48 cases, urinary protein-positive in 27 cases. The autoantibodies were detected in 25 patients with T1DM. The positive rate of islet cell antibody was 28%, the positive rate of insulin autoantibodies was 20%, the level of GADA was (12.0 ± 1.8)%, The positive rate was 72%. Conclusions The number of children with first diagnosed DM increases year by year with the predominance of T1DM; the increase of newborn’s DM is obvious; DKA is an important reason for the treatment of T1DM. In the first diagnosis of T1DM, infection is an important cause of DKA; Hypothyroidism, liver and kidney dysfunction and dyslipidemia; the highest positive rate of GADA in diabetic autoantibodies.