摘要
目的 明确以酮症为首发表现的糖尿病患者临床及自然病程特征。方法 测定 6 0例初发酮症期平均年龄为 (42 .78± 11.14 )岁、体质指数 (BMI)为 (2 4 .34± 3.4 7) kg/m2 的糖尿病患者的胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体 (GAD)及空腹和糖负荷后的血糖及胰岛素水平 ;经胰岛素治疗后根据血糖水平调整治疗方案 ;随访期复查上述各项指标。结果 经胰岛素治疗纠正酮症和控制血糖 2周后 ,出院时改为口服药物者 2 7例 ,仍用胰岛素治疗者 33例 ;平均随访时间 2 .6 2年 ;随访期患者 2 7例胰岛素治疗 ,33例口服降糖药治疗。比较随访期间胰岛素与口服药治疗组患者 ,初发酮症期及随访期 ,口服药物组患者 BMI显著增高〔初发酮症期 (2 5 .6 9± 2 .6 6 ) kg/m2 比 (2 2 .6 4± 3.75 ) kg/m2 ,P =0 .0 0 1;随访期 (2 6 .19± 3.11) kg/m2 比 (2 2 .2 9±2 .97) kg/m2 ,P =0 .0 0 0〕,糖负荷后胰岛素水平显著增高〔初发酮症期 (32 .39± 35 .87) m U /L比 (18.5 3±14 .4 3) m U /L ,P =0 .0 17;随访期 (6 7.34± 6 8.4 2 ) m U/L比 (36 .4 0± 4 5 .39) m U /L ,P=0 .0 0 4〕,糖化血红蛋白 (Hb A1 C)降低〔初发酮症期 (10 .76± 1.2 5 ) %比 (12 .0 4± 1.99) % ,P=0 .0 0 6 ;随访期 (6 .97± 1.31) %比(9.36± 3.
Objective To study the clinical characteristics and natural history of adult diabetic patients with ketosis as the initial manifestation. Methods In 60 patients with ketosis as the initial symptom,the mean age was(42.78±11.14)years and body mass index(BMI) was (24.34±3.47)kg/m 2. The islet cell antibody (ICA),antiglutamic acid decarboxylase(GAD) antibody,fast plasma glucose and insulin level, glucose and insulin level of 2 hours after oral glucose test were measured. After insulin therapy,these patients received therapy plan according to their glucose level. During followup period,these items were tested again. Results There were 27 patients using insulin and 33 patients using diet or oral hypoglycemic drugs for controlling blood glucose during the followup. Compared with patients using insulin therapy, patients using oral hypoglycemic drugs or diet therapy showed higher BMI 〔at onset of ketosis (25.69±2.66)kg/m 2 vs. (22.64±3.75)kg/m 2,P =0.001;during followup period (26.19±3.11)kg/m 2 vs. (22.29±2.97)kg/m 2,P =0.000〕,higher postload serum insulin level〔at onset of ketosis (32.39± 35.87)mU/L vs. (18.53±14.43)mU/L,P =0.017;during followup period (67.34±68.42)mU/L vs. (36.40±45.39)mU/L,P =0.004〕,lower HbA_1C〔at onset of ketosis (10.76±1.25)% vs. (12.04±1.99)%,P =0.006;during followup period (6.97±1.31)% vs. (9.36±3.18)%,P =0.000〕,higher percentage of ICA and GAD positivity(at onset of ketosis,ICA positive rate was 18.52% vs. 0,P =0.030,GAD positive rate was 18.52% vs. 0,P =0.030; during followup period,ICA positive rate was 7.41% vs. 0,P =0.111, GAD positive rate was 14.81% vs. 0, P =0.022). Conclusion Among the adult diabetic patients with ketosis as the first symptom,quite a number of patients are not insulin dependent for the longterm blood sugar control. Ketosis is not a good index for differentiating type 1 from type 2 diabetes.
出处
《中国危重病急救医学》
CAS
CSCD
2004年第5期299-302,共4页
Chinese Critical Care Medicine
关键词
糖尿病
胰岛素治疗
酮症
diabetes mellitus
insulin treatment
ketosis
