2020 年第 2 期 第 15 卷

新诊断合并糖尿病酮症酸中毒的1型糖尿病和2型糖尿病患者临床特征比较

Clinical characteristics of newly diagnosed type 1 and type 2 diabetes mellitus complicated with ketoacidosis

作者：谭晓娟王慧张瑞

英文作者：

单位：陆军军医大学第二附属医院内分泌科，重庆400037

英文单位：

关键词：1型糖尿病；2型糖尿病；糖尿病酮症酸中毒；临床特征

英文关键词：

• 摘要：

• 【摘要】目的    了解合并糖尿病酮症酸中毒(DKA)的新诊断1型糖尿病与2型糖尿病患者的临床特征，更好认识DKA患者的临床差异，以提高DKA诊治水平。方法    收集陆军军医大学第二附属医院2016年2月至2019年1月收治的86例DKA住院患者临床资料，回顾性分析比较以DKA为首诊的新诊断1型糖尿病与2型糖尿病患者的患者人口学特征、入院时血常规、肝肾功、电解质等实验室检查结果及预后等临床情况。结果    1型糖尿病DKA患者中新诊断糖尿病患者占62.9%（22/35），2型糖尿病DKA患者中新诊断糖尿病患者占31.4%（16/51）。新诊断1型糖尿病DKA患者与新诊断2型糖尿病DKA患者比较，起病年龄小、糖化血红蛋白、血肌酐、碳酸氢根离子浓度低，但急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、病死率、β-羟丁酸水平高［（33±14）岁比（43±16）岁、（11.4±3.1）%比（14.3±2.1）%、（98±33）μmol/L比（189±113）μmol/L、（5.5±2.3）mmol/L比（8.5±5.3）mmol/L、（13±6）分比（10±6）分、31.8%（7/22）比6.2%（1/16）、（7.6±2.3）mmol/L比（5.2±3.0）mmol/L］，差异均有统计学意义（均P<0.05）；新诊断1型糖尿病患者DKA病情有更严重的趋势，但差异无统计学意义（P=0.057）。结论    新诊断1型糖尿病DKA患者起病年龄轻，APACHEⅡ评分高，病情重，病死率高；新诊断2型糖尿病DKA患者更易出现急性肾功能不全。

• 【Abstract】Objective    To explore the clinical characteristics of newly diagnosed type 1 diabetes mellitus(T1DM) and type 2 diabetes mellitus(T2DM) complicated with diabetic ketoacidosis(DKA). Methods    Demographic data, laboratory results including blood routine, liver and kidney function, electrolytes and the prognosis of 86 cases of T1DM and T2DM complicated with DKA admitted to the Second Affiliated Hospital of Army Medical University from February 2016 to January 2019 were retrospectively analyzed. Results    There were 35 cases of T1DM and 62.9%（22/35） of them were newly diagnosed. There were 51 cases of T2DM and 31.4%（16/51） of them were newly diagnosed. Compared with newly diagnosed T2DM patients, newly diagnosed T1DM patients showed lower age, lower levels of glycosylated hemoglobin, serum creatinine and bicarbonate ion, higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, mortality rate and β-hydroxybutyric acid level［（33±14）years vs （43±16）years, （11.4±3.1）% vs （14.3±2.1）%, （98±33）μmol/L vs （189±113）μmol/L, （5.5±2.3）mmol/L vs （8.5±5.3）mmol/L, （13±6） vs （10±6）, 31.8%（7/22） vs 6.2%（1/16）, （7.6±2.3）mmol/L vs （5.2±3.0）mmol/L］（all P<0.05）. DKA severity was more serious in patients with newly diagnosis of T1DM（P=0.057）. Conclusions    Newly diagnosed T1DM with DKA is more likely to occur in young patients with high APACHEⅡ score and mortality. Newly diagnosed T2DM with DKA patients are susceptible to acute renal insufficiency.