论文部分内容阅读
目的分析青少年1型和2型糖尿病发病的临床特点、鉴别诊断。方法回顾性分析北京协和医院内分泌科2000—2005年收治的111例1型糖尿病和75例2型糖尿病患者,年龄<30岁。分析各项临床和试验室指标的差异,OR和受试者工作特征曲线(ROC曲线)。结果 1型糖尿病易出现发病前感染(35.1%)、糖尿病酮症酸中毒(71.2%)。2型糖尿病患者更易有肥胖史(95.7%)、脂肪肝(70.7%)和黑棘皮症(54.7%),BMI[(28.12±4.38)kg/m~2]、空腹C肽(FC-P)[2.80(0.5～8.2)ng/ml]、HOMA2-IR[1.7(0.4～6.1)]较高(P<0.05)。OR值最高的为黑棘皮症,无穷大(∞),其次为脂肪肝(78.6)、肥胖史(8.5)。计算AUC,最高为BMI、HOMA2-IR、FC-P,诊断2型糖尿病的最佳切点为BMI=23 kg/m~2、HOMA2-IR=0.75、FC-P=1.0ng/ml。结论在青少年中两种糖尿病最具鉴别的指标为黑棘皮症、脂肪肝、肥胖史及BMI,HOMA2-IR,FC-P。
Objective To analyze the clinical features and differential diagnosis of juvenile type 1 and type 2 diabetes mellitus. Methods The clinical data of 111 type 1 diabetic patients and 75 type 2 diabetic patients who were admitted to Department of Endocrinology, Peking Union Medical College Hospital during 2000-2005 were retrospectively analyzed. The patients were under 30 years old. Differences in clinical and laboratory parameters, OR and receiver operating characteristic curves (ROC curves) were analyzed. Results Type 1 diabetes was prone to pre-infection (35.1%) and diabetic ketoacidosis (71.2%). Patients with type 2 diabetes were more likely to have obesity history (95.7%), fatty liver (70.7%) and acanthosis nigricans (54.7%), BMI [28.12 ± 4.38 kg / m 2], fasting C-peptide [2.80 (0.5-8.2) ng / ml] and HOMA2-IR [1.7 (0.4-6.1)] were higher (P <0.05). The highest OR was acanthosis nigricans, infinity (∞), followed by fatty liver (78.6) and obesity history (8.5). The best cut-points for the diagnosis of type 2 diabetes were BMI = 23 kg / m ~ 2, HOMA2-IR = 0.75 and FC-P = 1.0 ng / ml for calculating AUC and up to BMI, HOMA2-IR and FC- Conclusion The most discriminating indicators of the two types of diabetes in adolescents are acanthosis nigricans, fatty liver, obesity history and BMI, HOMA2-IR and FC-P.