Makovi Helga, Soltész Gyula, Hermann Róbert
Gyór, Csecsemó- és Gyermekosztály, Petz Aladár Megyei Kórház.
Orv Hetil. 2002 Nov 3;143(44):2489-92.
Immune mediated type 1 diabetes is the most frequent form of childhood diabetes while type 2 and other forms are more rare in childhood in the Caucasian population. Differentiation of various diabetes subtypes has importance in the choice of treatment and prognosis.
The aim of the study was to describe clinical heterogeneity of childhood diabetes and to evaluate possibilities of phenotypical classification.
Two hundred twenty eight children (128 girls and 100 boys) with diabetes diagnosed at the Department of Pediatrics, University of Pécs, in the period of 1978-2000 were examined. Glycated hemoglobin levels, insulin requirement, body weight at diagnosis and association of type 1 diabetes with other disorders were analysed.
Thirty one patients (13.6%) had permanently low (< 8%) glycated hemoglobin levels. Low glycated hemoglobin level associated with low insulin requirement (< 0.5 U/kg/day) was observed in three patients (1.4%) with 4 years of disease duration and in 2 patients (0.9%) during the whole disease course. These patients can be classified as non-classical type 1 diabetes cases. Obesity associated with less than 0.5 U/kg/day insulin requirement observed at least for two years from diagnosis was found in 2 cases (0.9%). These cases may be diagnosed as having childhood type 2 diabetes. The authors identified two diabetes patients with Down syndrome while MODY and transient neonatal diabetes were observed in one cases each. Diabetes associated conditions diagnosed in single cases each were as follows: thymus tumor, Duchenne muscular dystrophy, autoimmune polyglandular syndrome type 2, and T-cell lymphoma.
Childhood diabetes cases can be classified into several subgroups on clinical grounds, insulin requirement, and glycemic control. The data suggest that the prevalence of type 2 and non-classical type 1 diabetes is probably only a few percent among children with diabetes in Hungary. Due to phenotypic overlap between different forms of diabetes, measurement of beta-cell specific autoantibodies and C peptide levels can be recommended for etiologic classification.
免疫介导的1型糖尿病是儿童糖尿病最常见的形式，而2型糖尿病和其他类型在白种人儿童中则较为罕见。区分不同的糖尿病亚型对于治疗选择和预后具有重要意义。
本研究的目的是描述儿童糖尿病的临床异质性，并评估表型分类的可能性。
对1978年至2000年期间在佩奇大学儿科学系诊断为糖尿病的228名儿童（128名女孩和100名男孩）进行了检查。分析了糖化血红蛋白水平、胰岛素需求量、诊断时的体重以及1型糖尿病与其他疾病的关联。
31名患者（13.6%）糖化血红蛋白水平持续较低（<8%）。在病程4年的3名患者（1.4%）和整个病程中的2名患者（0.9%）中观察到糖化血红蛋白水平低与胰岛素需求量低（<0.5 U/kg/天）相关。这些患者可归类为非典型1型糖尿病病例。在2例患者（0.9%）中发现肥胖与诊断后至少两年内胰岛素需求量低于0.5 U/kg/天相关。这些病例可能被诊断为儿童2型糖尿病。作者发现了2例患有唐氏综合征的糖尿病患者，同时分别在1例患者中观察到了青少年发病的成年型糖尿病和短暂性新生儿糖尿病。单例诊断的糖尿病相关病症如下：胸腺瘤、杜氏肌营养不良症、2型自身免疫性多内分泌腺综合征和T细胞淋巴瘤。
儿童糖尿病病例可根据临床情况、胰岛素需求量和血糖控制分为几个亚组。数据表明，在匈牙利糖尿病儿童中，2型和非典型1型糖尿病的患病率可能仅为百分之几。由于不同形式糖尿病之间存在表型重叠，建议检测β细胞特异性自身抗体和C肽水平进行病因分类。
