Diabetes Care:警惕!青少年糖尿病患者患致命性酮症酸中毒的发病率增加

2021-08-01 MedSci原创 MedSci原创

2010年至2016年,1型糖尿病诊断时或接近诊断时的DKA患病率有所上升

糖尿病酮症酸中毒(DKA)是一种严重的、可能危及生命的糖尿病并发症。在糖尿病发病时,DKA的特点是高血糖、酮症和酸中毒,这是由于胰岛素缺乏和反调节激素(胰高血糖素、儿茶酚胺、皮质醇和生长激素)水平增加造成的。DKA严重的急性发病率(如脑水肿)和死亡可能发生。

DKA通常发生在糖尿病诊断时,年幼的儿童风险最大,这可能是因为年幼儿童的糖尿病症状更容易不被发现。虽然父母患有糖尿病的儿童和自己患糖尿病的儿童在诊断糖尿病时患DKA的可能性较小,但总体比例仍然高得令人担忧(24%对1型糖尿病交换登记的41%)。

青年发病(<20岁)糖尿病的多地点登记,青年糖尿病研究(SEARCH),以前报告了2002年至2010年期间1型糖尿病诊断时DKA的高但稳定的流行率(˜30%)。然而,在最近一项基于转诊的单一糖尿病中心的研究中(n = 2429),观察到1型糖尿病诊断时的DKA从2010年的41%上升到2017年的58%。

SEARCH研究记录了新诊断的1型糖尿病青年的人口统计学特征分布随着时间的推移而变化。鉴于1型糖尿病发病时的DKA频率在不同的人口群体中存在差异,假设诊断时DKA的增加至少可以部分解释为被诊断为糖尿病的青少年人口特征的变化。

为此,来自北卡罗来纳州温斯顿-塞勒姆的专家试图评估2010年至2016年小于20岁的青年诊断1型糖尿病时的DKA患病率的时间趋势,并评估观察到的任何变化是否与最近诊断者的社会人口分布变化有关。结果发表在Diabetes Care杂志上。

研究人员按年份计算了1型糖尿病诊断后1个月内的DKA患病率,并评估了不同时期(2010-2016年)的趋势(n = 7612个糖尿病发病病例;诊断时平均[SD]年龄为10.1[4.5])。为了评估所观察到的趋势是否归因于社会人口因素在青少年1型糖尿病患者中的分布变化,估计了与日历年有关的DKA的调整相对风险(RR)。

在SEARCH研究中,1型糖尿病诊断时DKA的流行趋势(2010-2016)。

结果显示,DKA患病率从2010年的35.3%(95% CI 32.2, 38.4)增加到2016年的40.6%(95% CI 37.8, 43.4)。对社会人口学因素的调整并没有实质性地改变观察到的趋势。同时,研究人员观察到1型糖尿病诊断时或接近诊断时的DKA患病率每年增加2%(RR=1.02 [95% CI 1.01, 1.04]和调整RR=1.02 [95% CI 1.01, 1.04])。

对缺失数据的检查表明,19.6%的登记病例缺少一个或多个关键协变量的数据,这些数据可以解释糖尿病发病时或接近发病时DKA的任何变化趋势。在研究期间观察到家庭收入较高和有医疗补助或医疗保险的登记病例比例增加。

青年1型糖尿病诊断时DKA患病率的相对年度增长情况(2010-2016年)

综上,2010年至2016年,1型糖尿病诊断时或接近诊断时的DKA患病率有所上升,此前2002年至2010年观察到的患病率较高但稳定。

 

参考文献:

Increase in Prevalence of Diabetic Ketoacidosis at Diagnosis Among Youth With Type 1 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021 Jul; 44(7): 1573-1578. https://doi.org/10.2337/dc20-0389

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style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Wed Sep 08 16:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823735, encodeId=d0f71823e359e, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Wed Sep 08 23:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2045899, encodeId=53ff2045899a6, content=<a href='/topic/show?id=82e1989e3ff' target=_blank style='color:#2F92EE;'>#青少年糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98973, encryptionId=82e1989e3ff, topicName=青少年糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f984116, createdName=kzlchina, createdTime=Sun Sep 05 21:15:19 CST 2021, time=2021-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319146, encodeId=087f1319146d1, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Tue Aug 03 11:15:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346137, encodeId=02b1134613e6c, content=<a href='/topic/show?id=ecbb9553661' target=_blank style='color:#2F92EE;'>#酮症酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95536, encryptionId=ecbb9553661, topicName=酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=wgsun, createdTime=Tue Aug 03 11:15:19 CST 2021, time=2021-08-03, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1641220, encodeId=4d4b1641220df, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Sun May 08 14:15:19 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761647, encodeId=ed7d1e61647ea, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Tue Apr 12 18:15:19 CST 2022, time=2022-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2037548, encodeId=f245203e5482d, content=<a href='/topic/show?id=862b9553521' target=_blank style='color:#2F92EE;'>#酮症酸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95535, encryptionId=862b9553521, topicName=酮症酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c6262500044, createdName=1249862am72(暂无昵称), createdTime=Wed Mar 23 00:15:19 CST 2022, time=2022-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639829, encodeId=6f8a16398296d, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, 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style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Wed Sep 08 16:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823735, encodeId=d0f71823e359e, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Wed Sep 08 23:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), 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  9. [GetPortalCommentsPageByObjectIdResponse(id=1641220, encodeId=4d4b1641220df, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Sun May 08 14:15:19 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761647, encodeId=ed7d1e61647ea, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, 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style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Wed Sep 08 16:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823735, encodeId=d0f71823e359e, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Wed Sep 08 23:15:19 CST 2021, time=2021-09-08, status=1, ipAttribution=), 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createdName=mashirong, createdTime=Tue Aug 03 11:15:19 CST 2021, time=2021-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346137, encodeId=02b1134613e6c, content=<a href='/topic/show?id=ecbb9553661' target=_blank style='color:#2F92EE;'>#酮症酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95536, encryptionId=ecbb9553661, topicName=酮症酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=346311, createdName=wgsun, createdTime=Tue Aug 03 11:15:19 CST 2021, time=2021-08-03, status=1, ipAttribution=)]
    2021-08-03 mashirong
  10. 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拓展阅读

没有血酮试剂如何治疗糖尿病酮症酸中毒

实际可以通过尿常规和血来监测酮体。我们经常通过查尿常规中的尿酮体判断,而尿酮体中查的是乙酰乙酸、β-羟基丁酸及丙酮。导致我们的判断会有偏差。而β-羟基丁酸来判断是否为糖尿病酮症酸中毒才是最正确的。

Lancet Diabetes & Endocrinology:持续血糖监测与血糖监测对儿童、青少年和年轻1型糖尿病患者严重低血糖和糖尿病酮症酸中毒风险的影响

本研究提供的证据表明,与使用血糖监测的年轻人相比,使用持续血糖监测的1型糖尿病患者发生严重低血糖和糖尿病酮症酸中毒的风险更低,更重要的是,低血糖昏迷和严重酮症酸中毒的风险更低。

World J Diabetes:糖尿病酮症酸中毒患者入住重症监护病房的临床和生化预测因素

根据血清pH值、碳酸氢盐和精神状态,DKA分为轻度、中度和重度。

糖尿病酮症酸中毒诊断与急救规范

糖尿病酮症酸中毒是糖尿病患者血糖控制不良,引起的急性严重代谢紊乱疾病。糖尿病患者,胰岛素相对或绝对缺乏,可引起体内糖类、脂肪、蛋白质三者紊乱。糖类不能合成糖原储存,或者分解少,致血糖升高。

男子呼吸困难1天,医生说嗅到了烂苹果的味道!他最后被送入了ICU!

酮症酸中毒,是糖尿病患者的一种急性并发症。当糖尿病患者治疗不当或者其他原因导致血糖显著升高时,机体无法利用葡萄糖,只能转而利用脂肪,脂肪分解后产生很多酸性物质,酸性物质一堆积,就会产生很多不良影响。

糖尿病酮症酸中毒的管理

糖尿病酮症酸中毒(DKA)通常需要收治重症监护。然而,指南提供了不同的建议。我们建议用基于病理生理学的方法进行管理。DKA的诊断和解决标准在补充文件中描述。