摘要
目的了解青少年起病的成人型糖尿病(MODY)12型的临床特点、基因变异及治疗随访结局。方法回顾性病例研究。收集2016年1月至2023年12月于北京儿童医院住院及门诊就诊5例MODY12型患儿病例资料,基因检测结果均提示ABCC8基因变异,分析其临床特点,治疗随访情况和遗传学特点。结果5例MODY12型中男4例、女1例,年龄为13.4(5.5,14.6)岁。出生时巨大儿4例,小于胎龄儿1例。2例合并超重或者肥胖,3例有典型糖尿病症状,2例无意中发现血糖高。1例以糖尿病酮症酸中毒起病患儿新生儿期诊断先天性高胰岛素血症,二氮嗪治疗有效,伴智力发育落后。5例患儿家族中均有连续三代常染色体显性遗传的糖尿病史。起病时的空腹血糖7.5(6.5,10.0)mmol/L,糖化血红蛋白(HbA1c)为11.8%(7.5%,13.5%),空腹C肽1.2(1.1,2.2)μg/L,随访时间15(9,32)个月,1例生活方式干预,2例口服二甲双胍,1例胰岛素加磺脲类药物治疗,1例胰岛素治疗。随访时的空腹血糖6.1(5.1,7.0)mmol/L,HbA1c为5.9%(5.7%,7.1%),空腹C肽1.7(0.9,2.9)μg/L。1例并发糖尿病视网膜病变。5例患儿共发现4个ABCC8基因杂合错义变异,1个整码缺失,均来源于母亲。结论MODY12型患儿起病年龄从婴儿期至青春期,临床异质性强,从轻度血糖升高到酮症酸中毒起病,肥胖发生率高,以ABCC8基因错义变异为主。个体化地根据血糖情况制定治疗方案,血糖控制较好。
Objective To analyze the genetic and clinical characteristics,treatment and prognosis of patients diagnosed with maturity onset of diabetes of the young(MODY)12 subtype.Methods This retrospective study collected and analyzed data from 5 children with MODY12 subtype caused by ABCC8 gene variants who underwent inpatient and outpatient genetic testing at Beijing Children′s Hospital from January 2016 to December 2023.Their clinical and genetic features,treatment,and follow-up results were analyzed.Results Among the 5 patients with MODY12 subtype,4 were male and 1 was female,with an age of 13.4(5.5,14.6)years.Four of the patients were born large for gestational age,while one was born small for gestational age.Two patients were overweight or obese.Three patients exhibited typical symptoms of diabetes,while 2 were incidentally found to have elevated blood glucose level.One patient was found to have diabetic ketoacidosis at onset,who was diagnosed with congenital hyperinsulinism during the neonatal period and received diazoxide treatment,and experienced intellectual developmental delay.All 5 patients had autosomal dominant inherited diabetes within 3 generations.The fasting blood glucose at onset was 7.5(6.5,10.0)mmol/L,the haemoglobin A1c(HbA1c)was 11.8%(7.5%,13.5%),and the fasting C-peptide was 1.2(1.1,2.2)μg/L.The duration of follow-up was 15(9,32)months.One patient underwent lifestyle intervention,2 received metformin orally,1 received insulin therapy,and the other received subcutaneous injection of insulin combined with sulfonylurea orally.At the last follow-up,the median fasting blood glucose was 6.1(5.1,7.0)mmol/L,the HbA1c was 5.9%(5.7%,7.1%),and the fasting C-peptide was 1.7(0.9,2.9)μg/L.One patient developed diabetic retinopathy.There were 4 missense variations in ABCC8 gene and one in-frame deletion,all of which were maternally inherited heterozygotes.Conclusions MODY12 subtype is a heterogeneous disorder with the age of onset from infancy to adolescence.It can present as mild hyperglycemia or diabetic ketoacidosis,and has a high incidence of obesity.Definitive diagnosis can be achieved through genetic test,and individualized treatment is recommended based on glucose levels.
作者
曹冰燕
苗苗
王冬梅
孟曦
巩纯秀
Cao Bingyan;Miao Miao;Wang Dongmei;Meng Xi;Gong Chunxiu(Department of Endocrinology,Genetics and Metabolism,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045;the Department of Pediatrics,Beijing Mentougou District Maternal and Child Health Hospital,Beijing 102308,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2024年第6期530-534,共5页
Chinese Journal of Pediatrics
关键词
儿童
糖尿病
遗传性疾病
基因检测
预后
Child
Diabetes mellitus
Genetic diseases
Genetic testing
Prognosis
