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目的探讨不同病程酮症倾向糖尿病患者的临床特征及胰岛β细胞功能的变化。方法选择69例发生酮症或酮症酸中毒的糖尿病患者为研究对象,入院后记录血压、身高、体重、腰围、臀围等一般资料,检测血糖、血酮、血气分析、糖化血红蛋白(HbA1 c)、血脂、胰岛自身抗体、空腹及餐后2 h C肽。结果 (1)抗体阴性组(n=56)糖尿病患者发病年龄比抗体阳性组(n=13)大,收缩压、舒张压、体质指数、三酰甘油、空腹及餐后2 h C肽均较抗体阳性组高,血酮及HDL-C较抗体阳性组低,差异有统计学意义(P<0.05)。(2)短病程组(<6个月,n=38)糖尿病患者发病年龄比长病程组(≥6个月,n=18)小,短病程组中男性患者所占比例大,体质指数、腰臀比、三酰甘油、6个月后达到缓解期的患者比例均较长病程组高,酮症诱因所占比例低,差异有统计学意义(P<0.05)。(3)短病程糖尿病酮症患者中肥胖组(BM I≥25 kg/m2,n=18)发病年龄比非肥胖组(BM I<25 kg/m2,n=20)小,肥胖组中男性患者所占比例大,腰臀比、空腹及餐后2 h C肽、6个月后达到缓解期的患者比例均较非肥胖组高,差异有统计学意义(P<0.05)。结论短病程酮症患者可归类于酮症倾向2型糖尿病,且肥胖的酮症倾向糖尿病患者更易出现缓解期,在缓解期能基本恢复正常的胰岛素分泌。
Objective To investigate the clinical characteristics and changes of pancreatic β-cell function in ketosis-prone diabetic patients with different course of disease. Methods Sixty-nine diabetic patients with ketosis or ketoacidosis were selected as study subjects. Blood pressure, blood glucose, blood gas analysis, HbA1c ), Lipids, islet autoantibodies, fasting and postprandial 2-h C-peptide. Results (1) In the antibody negative group (n = 56), the onset age of diabetic patients was larger than that of the antibody positive group (n = 13), systolic blood pressure, diastolic blood pressure, body mass index, triglyceride, fasting and postprandial 2h C peptide Antibody positive group, blood ketone and HDL-C antibody positive group was lower, the difference was statistically significant (P <0.05). (2) Short disease course group (<6 months, n = 38) The onset age of diabetic patients was smaller than that of the long course group (≥6months, n = 18). The proportion of male patients in the short course group was large, Waist-to-hip ratio, triglyceride, the proportion of patients who reached remission after 6 months were higher than those with longer course of disease, and the proportion of ketosis-inducing factors was lower, the difference was statistically significant (P <0.05). (3) The onset age of obesity group (BM I≥25 kg / m 2, n = 18) was shorter than that of non-obese group (BM I <25 kg / m 2, n = 20) The proportion of patients with large proportion of waist-hip ratio, fasting and postprandial 2-h C peptide, 6 months after the remission of patients than in non-obese group, the difference was statistically significant (P <0.05). Conclusions Patients with short course ketosis can be classified as ketosis-prone type 2 diabetes, and obese diabetic ketosis patients are more likely to have remission, which can basically resume normal insulin secretion during remission.