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目的:提高临床医师对以腹痛为首发症状的肥胖型2型糖尿病酮症酸中毒(DKA)并高脂血症(HL)性急性胰腺炎(AP)的认识。方法:回顾性分析我院2005年1月至2008年3月收治的9例肥胖型2型糖尿病酮症酸中毒并高脂血症性急性胰腺炎患者的临床资料。结果:(1)9例均为青年男性,年龄30.78±5.56岁;(2)病前均无糖尿病史及相关症状,均无高脂血症史;(3)病前均无暴饮、暴食和胆石症史;(4)均以腹痛为首发症状,均有腹压痛;(5)均为肥胖体型,体质指数28.33±1.54 kg/m2;(6)均达到DKA诊断标准;(7)入院时有7例血淀粉酶升高,其中6例超过正常值3倍以上,2例正常(其中1例入院后升高达正常值3倍以上);(8)入院时均有高脂血症,其中3例脂血,6例TG均>11.3 mmol/L,DKA纠正后(入院后第3天)TG降至1.1~1.8 mmol/L,TC降至3.6~4.6 mmol/L;(9)B超或CT均有胰腺炎改变;(10)治愈后症状解除,血TG、TC均正常或稍高,血尿淀粉酶均正常。结论:(1)以腹痛就诊的DKA患者,应常规查TG、TC、血尿淀粉酶、胰腺B超或CT,以排除高脂血症性胰腺炎;(2)青年肥胖型2型糖尿病可能以糖尿病酮症酸中毒并高脂血症性急性胰腺炎为首发表现入院。
Objective: To improve clinicians’ understanding of obesity type 2 diabetic ketoacidosis (DKA) and hyperlipidemia (HL) acute pancreatitis (AP) with abdominal pain as the first symptom. Methods: The clinical data of 9 patients with obese type 2 diabetic ketoacidosis and hyperlipidemic acute pancreatitis admitted to our hospital from January 2005 to March 2008 were retrospectively analyzed. Results: (1) All 9 cases were young men aged 30.78 ± 5.56 years old. (2) No history of diabetes and related symptoms before the illness, no history of hyperlipidemia. (3) No binge drinking, gluttony And cholelithiasis history; (4) bellyache as the first symptom, all have abdominal tenderness; (5) are obese, body mass index 28.33 ± 1.54 kg / m2; (6) meet the DKA diagnostic criteria; There were 7 patients with elevated serum amylase, of whom 6 were more than 3 times normal and 2 were normal (1 of them increased more than 3 times of normal after admission); (8) All patients had hyperlipidemia, (3) TG decreased to 1.1 ~ 1.8 mmol / L and TC decreased to 3.6 ~ 4.6 mmol / L after DKA correction (3 days after admission); (9) B Ultra or CT have pancreatitis changes; (10) cured symptoms, blood TG, TC were normal or slightly higher, hematuria amylase were normal. Conclusion: (1) DKA patients with abdominal pain should routinely check TG, TC, amylase, hematuria, pancreatic B ultrasound or CT to exclude hyperlipidemic pancreatitis; (2) young obese type 2 diabetes may be Diabetic ketoacidosis and hyperlipidemic acute pancreatitis as the first performance of admission.