Sue Mariko, Yoshihara Aya, Otani Takatoshi, Tsuchida Yasuyo, Higa Mariko, Hiroi Naoki
Department of Internal Medicine, Saiseikai Kanagawa-ken Hospital, Yokohama, Japan.
Med Sci Monit. 2008 Oct;14(10):CS97-101.
Fulminant type 1 diabetes is characterized by acute onset and rapid development of ketoacidosis.
We present three cases of fulminant type 1 diabetes we experienced at our hospital. All three patients showed extremely high levels of plasma glucose, low HbA1c levels, positivity for urinary ketone bodies, ketoacidosis, and low C-peptide excretion. Flu-like symptoms were noted a few days before hospitalization, and increases in the WBC and CRP levels were observed. Interestingly, case 1 was negative for anti-GAD antibody at the time of hospitalization but became positive 22 days later. Moreover, this patient reverted to being negative for anti-GAD antibody 93 days later. Cases 1 and 3 were positive for HLA-DR4 and HLA-DR9, and Case 2 was positive for HLA-DR4. All three individuals had flu-like symptoms and showed inflammatory markers in the blood.
Although autoimmune abnormalities are not usually linked with fulminant type 1 diabetes, the conclusion drawn from the present study is that patients with this disease should be monitored on several different occasions for autoimmune antibodies.
暴发性1型糖尿病的特点是急性起病且酮症酸中毒迅速发展。
我们呈现我院收治的3例暴发性1型糖尿病病例。所有3例患者均表现为血糖水平极高、糖化血红蛋白（HbA1c）水平低、尿酮体阳性、酮症酸中毒以及C肽排泄量低。住院前几天出现类似流感的症状，且白细胞（WBC）和C反应蛋白（CRP）水平升高。有趣的是，病例1在住院时抗谷氨酸脱羧酶（GAD）抗体为阴性，但22天后转为阳性。此外，该患者在93天后抗GAD抗体又转为阴性。病例1和病例3 HLA - DR4和HLA - DR9呈阳性，病例2 HLA - DR4呈阳性。所有3人均有类似流感的症状且血液中显示有炎症标志物。
尽管自身免疫异常通常与暴发性1型糖尿病无关，但本研究得出的结论是，对于该疾病患者应在不同时间多次监测自身免疫抗体。
