Neu Andreas, Willasch Andre, Ehehalt Stefan, Hub Regine, Ranke Michael B
University of Tuebingen, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
Pediatr Diabetes. 2003 Jun;4(2):77-81. doi: 10.1034/j.1399-5448.2003.00007.x.
Since 1987, patients with newly diagnosed diabetes mellitus type 1 under 15 yr of age have been registered in Baden-Wuerttemberg (BW), Germany.
Our aim was to describe the frequency and the clinical presentation of diabetic ketoacidosis (DKA) at onset of type 1 diabetes mellitus in children.
All 31 pediatric departments in BW and one diabetes center participated in this study. Hospital records of 2121 children below 15 yr of age were examined retrospectively. DKA was defined as glucose > 250 mg/dL, pH < 7.30 or bicarbonate < 15 mmol/L and ketonuria. Statistical analysis was done after logarithmic transformation.
26.3% (n = 558) of all patients presented with DKA. The mean age of these patients was 7.9 yr. The frequency of DKA is higher in girls than in boys (28.9 vs. 23.8%; p = 0.0079). Those aged 0-4 yr suffered most frequently (p < 0.0001) from ketoacidosis (36.0%). The percentage of DKA in newly diagnosed cases was constant over 10 yr. 23.3% of all patients with DKA presented with an altered level of consciousness; 10.9% of these had clinical signs of coma. No deaths occurred. The proportion of ketoacidosis does not increase concurrently with the number of diabetes manifestations in winter.
The proportion of DKA in children with newly diagnosed diabetes mellitus is significant. In particular, children < 5 yr and girls face an increased risk. DKA may be the result of a particularly aggressive subtype of diabetes.
自1987年以来，德国巴登 - 符腾堡州（BW）已对15岁以下新诊断的1型糖尿病患者进行登记。
我们的目的是描述儿童1型糖尿病发病时糖尿病酮症酸中毒（DKA）的发生率和临床表现。
BW的所有31个儿科科室和一个糖尿病中心参与了本研究。回顾性检查了2121名15岁以下儿童的医院记录。DKA定义为血糖>250mg/dL、pH<7.30或碳酸氢盐<15mmol/L且尿酮阳性。对数转换后进行统计分析。
所有患者中有26.3%（n = 558）出现DKA。这些患者的平均年龄为7.9岁。DKA在女孩中的发生率高于男孩（28.9%对23.8%；p = 0.0079）。0 - 4岁的儿童最常发生酮症酸中毒（p < 0.0001）（36.0%）。新诊断病例中DKA的百分比在10年中保持不变。所有DKA患者中有23.3%出现意识水平改变；其中10.9%有昏迷的临床体征。无死亡病例发生。冬季酮症酸中毒的比例并不随糖尿病表现数量的增加而同时增加。
新诊断的糖尿病儿童中DKA的比例较高。特别是5岁以下儿童和女孩面临的风险增加。DKA可能是糖尿病一种特别侵袭性亚型的结果。
