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目的探索以酮症起病的糖尿病患者的分型方法和评估这类患者的预后。方法根据胰岛细胞自身抗体是否阳性(A+、A-)及β细胞功能是否保留(β+、β-)将以酮症起病的99例糖尿病患者分成4组:A+β-组(17例),A-β-组(26例),A+β+组(10例)以及A-β+组(46例)。比较各组发病时的临床特点、改良的稳态模型(HOMA2)指数以及出院6个月后的病情转归。结果4组患者在入院时及出院半年后的多项指标上均有显著差别。A+β-组患者平均发病年龄为19.1岁,酮症酸中毒复发率为29.4%,胰岛素停用率为0%;A-β-组患者临床特点类似于A+β-组,但一级亲属糖尿病的患病率相对较高(38.5% vs 17.5%);A-β+组平均发病年龄为44.5岁,伴有明显的代谢紊乱,随访时间内酮症复发率低(2.2%,与A+β-组相比P<0.01),胰岛素停用率高(50%,与A+β-、A-β-组相比P<0.01);A+β+组临床特点类似于A-β+组。结论就区分酮症起病的糖尿病患者而言,A+β-、A-β-、A+β+及A-β+4组患者可分别对应于自身免疫性1型糖尿病、特发性1型糖尿病,成人隐匿型自身免疫性糖尿病及2型糖尿病。
Objective To explore the classification of diabetic patients with ketosis and to evaluate the prognosis of these patients. Methods Ninety-nine diabetic patients with Ketosis onset were divided into four groups according to whether the islet cell autoantibodies were positive (A +, A-) or whether the β-cell function was retained (β +, β-): A + ), A-β group (26 cases), A + β + group (10 cases) and A-β + group (46 cases). The clinical features at onset of disease, the modified homeostasis model (HOMA2) index, and the outcome after 6 months of discharge were compared. Results There were significant differences among the four groups of patients on admission and six months after discharge. The mean age at onset of A + β-group was 19.1 years, the recurrence rate of ketoacidosis was 29.4%, and the rate of insulin withdrawal was 0%. The clinical features of A-β-group were similar to those of A + β-group, The prevalence of diabetes in relatives was relatively high (38.5% vs 17.5%); the average age of onset in A-beta + group was 44.5 years with significant metabolic disturbances and a low rate of ketosis recurrence at follow-up (2.2% (P <0.01 compared with A + β-A-β group). The clinical features of A + β group were similar to those of A-β + Group. CONCLUSIONS For the purpose of distinguishing diabetic patients with onset of ketosis, patients with A + beta, A beta, A beta beta and A beta beta 4 groups may correspond to autoimmune type 1 diabetes mellitus, idiopathic 1 Diabetes, adult-occult autoimmune diabetes and type 2 diabetes.