Koltin Dror, Daneman Denis
Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Diabetes. 2008 Oct;9(5):504-7. doi: 10.1111/j.1399-5448.2008.00404.x. Epub 2008 May 22.
We report in this study the death in bed of a 14-yr-old girl with type 1 diabetes and a review of the existing literature on this topic. Diagnosed at 5 yr of age, the patient followed a relatively benign disease course. Hemoglobin A1c was 6.6-8.4%, and there were no hospital admissions apart from the one at diagnosis. Hypoglycemic episodes were not excessive or severe. At age 14 yr, the patient was found dead in bed after having been well the night before. No apparent explanation could be provided. The 'dead-in-bed' syndrome accounts for 5-6% of mortality cases in patients with type 1 diabetes, amounting to two to six cases per 10 000 patient years. Theories attempting to explain the mechanism for this syndrome include hypoglycemia or cardiac autonomic dysfunction. This case emphasizes several problems faced by clinicians: the risk for sudden death in youth with diabetes, which may compromise good glycemic control, the question of early detection of autonomic dysfunction, and the need to understand this phenomenon better and search for preventive measures.
我们在本研究中报告了一名14岁1型糖尿病女孩的床上死亡病例，并对该主题的现有文献进行了综述。该患者5岁时被诊断出患有糖尿病，疾病进程相对平稳。糖化血红蛋白水平为6.6 - 8.4%，除诊断时住院一次外，无其他住院情况。低血糖发作并不频繁或严重。14岁时，患者前一晚状态良好，却被发现死在床上，无法给出明显死因。“床上死亡”综合征占1型糖尿病患者死亡病例的5 - 6%，相当于每10000患者年有2至6例。试图解释该综合征机制的理论包括低血糖或心脏自主神经功能障碍。该病例凸显了临床医生面临的几个问题：糖尿病青少年猝死的风险，这可能影响良好的血糖控制；自主神经功能障碍的早期检测问题；以及更深入了解这一现象并寻找预防措施的必要性。
