Edge J A, Hawkins M M, Winter D L, Dunger D B
Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
Arch Dis Child. 2001 Jul;85(1):16-22. doi: 10.1136/adc.85.1.16.
Cerebral oedema is a major cause of morbidity and mortality in children with insulin dependent diabetes.
To determine the risk and outcome of cerebral oedema complicating diabetic ketoacidosis (DKA).
All cases of cerebral oedema in England, Scotland, and Wales were reported through the British Paediatric Surveillance Unit between October 1995 and September 1998. All episodes of DKA were reported by 225 paediatricians identified as involved in the care of children with diabetes through a separate reporting system between March 1996 and February 1998. Further information about presentation, management, and outcome was requested about the cases of cerebral oedema. The risk of cerebral oedema was investigated in relation to age, sex, seasonality, and whether diabetes was newly or previously diagnosed.
A total of 34 cases of cerebral oedema and 2940 episodes of DKA were identified. The calculated risk of developing cerebral oedema was 6.8 per 1000 episodes of DKA. This was higher in new (11.9 per 1000 episodes) as opposed to established (3.8 per 1000) diabetes. There was no sex or age difference. Cerebral oedema was associated with a significant mortality (24%) and morbidity (35% of survivors).
This first large population based study of cerebral oedema complicating DKA has produced risk estimates which are more reliable and less susceptible to bias than those from previous studies. Our study indicates that cerebral oedema remains an important complication of DKA during childhood and is associated with significant morbidity and mortality. Little is known of the aetiology of cerebral oedema in this condition and we are currently undertaking a case control study to address this issue.
脑水肿是胰岛素依赖型糖尿病患儿发病和死亡的主要原因。
确定糖尿病酮症酸中毒（DKA）并发脑水肿的风险及预后。
1995年10月至1998年9月期间，通过英国儿科监测单位报告了英格兰、苏格兰和威尔士所有脑水肿病例。1996年3月至1998年2月期间，通过一个单独的报告系统，由225名确定参与糖尿病患儿护理的儿科医生报告了所有DKA发作情况。针对脑水肿病例，要求提供有关临床表现、治疗及预后的进一步信息。研究了脑水肿风险与年龄、性别、季节以及糖尿病是新诊断还是既往诊断之间的关系。
共确定34例脑水肿病例和2940次DKA发作。计算得出的发生脑水肿风险为每1000次DKA发作中有6.8例。新诊断糖尿病（每1000次发作中有11.9例）发生脑水肿的风险高于已确诊糖尿病（每1000次发作中有3.8例）。不存在性别或年龄差异。脑水肿与显著的死亡率（24%）和发病率（幸存者中的35%）相关。
这项首次基于大规模人群的DKA并发脑水肿研究得出的风险估计比以往研究更可靠且不易产生偏差。我们的研究表明，脑水肿仍是儿童期DKA的重要并发症，与显著的发病率和死亡率相关。目前对于这种情况下脑水肿的病因知之甚少，我们正在进行一项病例对照研究以解决这一问题。
