【作者】 江娟；

【导师】 黄亮；

【作者基本信息】 南昌大学 ， 全科医学（专业学位）， 2019， 硕士

【摘要】 目的:1、认识分析暴发性1型糖尿病发病及病情基本特点。2、探讨分析暴发性1型糖尿病患者的临床特征在不同年龄分布之间的异同点。方法:从2007年9月到2018年4月南昌市7家三级甲等医院住院的糖尿病患者中筛选出23例暴发性1型糖尿病,深入分析暴发性1型糖尿病患者的临床特征。同时通过知网、万方、维普三大中文数据库,输入“暴发性1型糖尿病”主题词或关键词查阅2007年9月到2018年4月国内关于FT1DM的论著和病例报道,去除重复、综述、会议及仅有摘要的文章,剩余144篇文献,筛选出至少有发病一般情况资料的438例FT1DM患者,再联合南昌市23例FT1DM患者,分析461例FT1DM患者的基本特点。最后从461例FT1DM患者中筛选出记录详尽的临床表现、实验室及影像学检查结果的FT1DM患者186例,按不同年龄划分为5组,分析不同年龄起病的FT1DM患者的基本特点、临床表现、实验室指标及影像学结果异同点。结果:1、南昌市23例FT1DM患者,12例男性,11例女性,发病年龄为(40.57±16.61)岁,病程为(3.26±1.94)天,发病后出现2例急性心肌损害,2例多器官功能损害,6例PF患者胎儿结局为胎死宫内,除了1例妊娠晚期女性患者死亡,22例患者均好转出院后继续胰岛素或降糖药物治疗。2、本组资料FT1DM患者在国内26个省、市、自治区均有报道,女性多于男性,最大起病年龄为76岁,最小起病年龄为9个月,除了2例FT1DM患者死亡,其他患者经过治疗后均好转出院。3、186例FT1DM患者发病血糖平均值为(38.34±14.41)mmol/L,病程为(3.82±2.46)天,糖化血红蛋白为(6.61±0.77)%,血清C肽水平极低,13例发现病毒抗体阳性,3例横纹肌溶解症,4例急性心肌损害,22例患者胰岛素相关抗体阳性,3例发病后促甲状腺激素受体抗体阳性。4、青年组(20岁-39岁)患者所占比例最高,超过所有暴发性1型糖尿病患者人数的一半;少儿组(0-19岁)患者在暴发性1型糖尿病患者中占有一定比例;少儿组(0-19岁)的高血糖症状、流感样症状、意识障碍发生率比其他三组均高(P<0.05),老年前期组(60岁-79岁)的高血糖症状发生率比其他三组均低(P<0.05),青年组(20岁-39岁)的流感样症状发生率比其他三组均低(P<0.05),壮年组(40岁-59岁)的意识障碍发生率比其他三组均低(P<0.05);少儿组(0-19岁)的体质量指数较其他三个年龄组偏低(P<0.05),而餐后2小时C肽水平较其他三个年龄组偏高(P<0.05),青年组(20岁-39岁)的血钠水平较壮年组(40岁-59岁)和老年前期组(60岁-79岁)偏低(P<0.05)。5、妊娠相关性暴发性1型糖尿病患者的胎儿致死率高,青年组(20岁-39岁)中妊娠相关性暴发性1型糖尿病体质量指数、血清白细胞计数较非妊娠相关性女性暴发性1型糖尿病高(P<0.05)。结论:1、暴发性1型糖尿病具有致死性,并可合并各个器官功能损害,妊娠相关性暴发性1型糖尿病患者胎死宫内发生率较高。妊娠相关性暴发性1型糖尿病患者与非妊娠相关性暴发性1型糖尿病患者相比,除了体质量指数、血清白细胞计数较高,其余的临床特征相似。2、不同年龄起病的暴发性1型糖尿病临床特征略有不同,在临床表现(高血糖症状、流感样症状、意识障碍发生率)、体质量指数、餐后2小时血清C肽、血钠水平有明显差异。少儿组(0-19岁)的高血糖症状、流感样症状、意识障碍发生率、餐后2小时C肽水平较其他三组均高,但少儿组的体质量指数较其他三个年龄组偏低。老年前期组(60岁-79岁)的高血糖症状发生率比其他三组均低。更多还原

【Abstract】 Objective:1.To understand and analyze the basic characteristics of the onset and condition of fulminant type 1 diabetes mellitus.2.To explore the similarities and differences of clinical characteristics patients with fulminant type 1 diabetes mellitus at different ages.Methods:From September 2007 to April 2018,23 cases of fulminant type 1 diabetes were selected from diabetic patients hospitalized in 7 tertiary hospitals in Nanchang,anddeeply analyze the clinical characteristics of Nanchang patients with fulminant type 1 diabetes mellitus.At the same time,through the Knowledge of How Net,Wan Fang,VIP three Chinese database,input subject word or keyword of "fulminant type 1 diabetes" to review the domestic FT1 DM articles and case reports from September 2007 to April 2018,and excluding duplicates,reviews,meetings,and abstract-only articles,the remaining 144 articles were screened out for 438 patients with FT1 DM who had at least general data on the onset of illness.And combined with 23 patients with FT1 DM in Nanchang,the basic characteristics of 461 patients with FT1 DM were analyzed.Finally,186 FT1 DM patients with detailed clinical manifestations,laboratory and imaging findings were screened from 461 FT1 DM patients,and divided into 5 groups according to different ages.The basic characteristics and clinical manifestations of FT1 DM patients with different ages were analyzed,laboratory indicators and imaging results similarities and differences.Results:1.23 cases of FT1 DM patients in Nanchang,12 males and 11 females,the age of onset was(40.57±16.61)years old,the course of disease was(3.26±1.94)days,2 cases of acute myocardial damage occurred after the onset,2 cases of multiple organ dysfunction,6 cases of PF patients The fetal outcome was intrauterine death,except for one female patient who died of late pregnancy,and 22 patients were better treated with insulin or hypoglycemic agents after discharge.2.This group of data FT1 DM patients reported in 26 provinces,municipalities and autonomous regions in China,more women than men,the maximum onset age is 76 years,the minimum onset age is 9 months,except for 2 patients with FT1 DM died,other patients passed After treatment,they were better discharged.3.The average blood glucose level of 186 patients with FT1 DM was(38.34±14.41)mmol/L,the course of disease was(3.82±2.46)days,the glycated hemoglobin was(6.61±0.77)%,the serum C-peptide level was extremely low,and 13 patients were found to be positive for viral antibodies.3 cases of rhabdomyolysis,4 cases of acute myocardial damage,22 cases of insulin-related antibody positive,3 cases of thyroid stimulating hormone receptor antibody positive after onset.4.The young group(20-39 years old)has the highest proportion of patients,more than half of all patients with fulminant type 1 diabetes;The children group(0-19 years old)account for a certain proportion of patients with fulminant type 1 diabetes;The incidence of hyperglycemia symptoms,flu-like symptoms,and disturbance of consciousness(0-19 years old)was higher than that of the other three groups(P<0.05).The incidence of hyperglycemia symptoms in the presenile group(60-79 years old)was lower than that of the other three groups(P<0.05).The incidence of flu-like symptoms was lower in the group(20-39 years)than in the other three groups(P<0.05).The incidence of disturbance of consciousness in the senior group(40-59 years)was lower than in the other three groups(P<0.05);the children group(0-19 years old)The body mass index was lower than the other three age groups(P<0.05),and the C-peptide level was higher in the 2 hours after meal than in the other three age groups(P<0.05).The blood sodium level in the young group(20-39 years old)was higher than that in the strong group(40 years old-59 years old)and the pre-age group(60-79 years old)are low(P<0.05).5.Pregnancy-related fulminant type 1 diabetes patients have a high fetal mortality rate.In the young group(20-39 years old),the body mass index and serum white blood cell count of pregnancy-related fulminant type 1 diabetes were higher than those of non-pregnancy-related women with fulminant type 1 diabetes(P<0.05).Conclusion:1.Fulminant type 1 diabetes is fatal and can be combined with dysfunction of various organs.The incidence of fetal death in patients with pregnancy-related fulminant type 1 diabetes is high.In pregnancy-related fulminant type 1 diabetes patients,in addition to body mass index and serum white blood cell count was higher,the remaining clinical features were similar to those of non-pregnancy-related fulminant type 1 diabetes.2.The clinical features of fulminant type 1 diabetes mellitus at different ages are slightly different.In clinical manifestations(hyperglycemia symptoms,flu-like symptoms,incidence of disturbance of consciousness),body mass index,serum C-peptide and blood sodium levels at 2 hours after meal significant differences.In the children group(0-19 years old),the symptoms of hyperglycemia,flu-like symptoms,the incidence of disturbance of consciousness,and the C-peptide level at 2 hours after meal were higher than those of the other three groups,but the body mass index of the children group was lower than that of the other three age groups.The incidence of hyperglycemia in the old-age group(60-79 years)was lower than that in the other three groups.更多还原