Kahara Toshio, Takamura Toshinari, Sakurai Masaru, Misu Hirofumi, Usuda Rika, Hayakawa Tetsuo, Nishimura Yasuyuki, Bando Yukihiro, Nagaoka Tadasu, Nagai Yukihiro, Kaneko Shuichi
Department of Diabetes and Digestive Disease, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
Diabetes Res Clin Pract. 2006 Mar;71(3):241-6. doi: 10.1016/j.diabres.2005.07.003. Epub 2005 Aug 19.
Although pancreatic exocrine enzymes are often elevated in patients with fulminant type 1 diabetes, the onset of this elevation and its significance in disease development remain unclear. We therefore investigated the significance of elevated serum enzyme concentrations and pancreatic swelling in the development of fulminant type 1 diabetes. Serum pancreatic exocrine enzymes, including amylase, elastase-I, lipase and trypsin, were measured during the course of the disease in 11 patients with fulminant type 1 diabetes (3 men and 8 women; a range of age 24-73 years, median 33 years; a range of HbA1c at onset 4.5-6.7%, median 6.0%), all of whom developed ketotic diabetes requiring intensive insulin therapy within a month. At least one pancreatic exocrine enzyme was elevated in each patient during the course of the disease. The concentration of enzymes on admission could not be correlated with urinary excretion of C-peptide. The time course of increase in serum amylase varied in these patients. In conclusion, neither the level of serum amylase nor the swelling of pancreas was associated with the onset or severity of fulminant type 1 diabetes. The pancreatic exocrine and endocrine events may occur concomitantly but independently during the course of fulminant type 1 diabetes.
尽管暴发性1型糖尿病患者的胰腺外分泌酶通常会升高，但这种升高的起始时间及其在疾病发展中的意义仍不清楚。因此，我们研究了血清酶浓度升高和胰腺肿胀在暴发性1型糖尿病发展中的意义。在11例暴发性1型糖尿病患者（3例男性和8例女性；年龄范围24 - 73岁，中位数33岁；发病时HbA1c范围4.5 - 6.7%，中位数6.0%）的病程中，测量了包括淀粉酶、弹性蛋白酶-I、脂肪酶和胰蛋白酶在内的血清胰腺外分泌酶，所有这些患者均在一个月内发展为需要强化胰岛素治疗的酮症糖尿病。在疾病过程中，每位患者至少有一种胰腺外分泌酶升高。入院时酶的浓度与C肽尿排泄量无相关性。这些患者血清淀粉酶升高的时间进程各不相同。总之，血清淀粉酶水平和胰腺肿胀均与暴发性1型糖尿病的发病或严重程度无关。在暴发性1型糖尿病病程中，胰腺外分泌和内分泌事件可能同时但独立发生。
