Ogiso Kazuma, Koriyama Nobuyuki, Akao Ayako, Otsuji Mayumi, Goto Takahiko, Fujisaki Natsuko, Minobe Machiko, Kinowaki Mayumi, Matsuki Shigeru
Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima, 892-0853 Japan.
Department of Diabetes and Nursing, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima, 892-0853 Japan.
J Diabetes Metab Disord. 2015 Sep 23;14:72. doi: 10.1186/s40200-015-0206-6. eCollection 2015.
We herein describe the case of a 29-year-old woman with type 1 diabetes from 10 years of age who developed adult cyclic vomiting syndrome. Beginning at 25 years of age, she was frequently hospitalized for stress-induced vomiting. Her vomiting episodes developed acutely and remitted after severe vomiting of more than 30 times a day for a few days. The vomiting periods were accompanied by leukocytosis with a predominance of neutrophils, high blood pressure and fever. In addition, it was noted that her levels of both adrenocorticotropic hormone and antidiuretic hormone during the vomiting attacks increased and subsequently dramatically decreased immediately after symptom improvement; therefore, she was diagnosed with adult-type cyclic vomiting syndrome in accordance with the diagnostic criteria of Rome III, a system developed to classify functional gastrointestinal disorders. Though glycemic control had improved with continuous subcutaneous insulin infusion therapy, the vomiting frequency increased due to the failure of drug treatments and general psychotherapy to terminate the vomiting attacks, making discharge difficult and greatly interfering with everyday life. Eventually, hypnotherapy and miniature garden therapy were prescribed, which significantly reduced the vomiting frequency, making it possible to discharge her from inpatient medical care. In the treatment of this patient with type 1 diabetes and adult-type cyclic vomiting syndrome, continuous subcutaneous insulin infusion therapy and comprehensive psychotherapy were effective.
我们在此描述一名10岁起患1型糖尿病的29岁女性发生成人周期性呕吐综合征的病例。从25岁开始，她因应激性呕吐频繁住院。她的呕吐发作急性起病，在每天严重呕吐超过30次持续数天后缓解。呕吐期伴有以中性粒细胞为主的白细胞增多、高血压和发热。此外，还注意到她在呕吐发作期间促肾上腺皮质激素和抗利尿激素水平均升高，症状改善后随即大幅下降；因此，根据罗马III诊断标准（一种用于对功能性胃肠疾病进行分类的系统），她被诊断为成人型周期性呕吐综合征。尽管持续皮下胰岛素输注治疗使血糖控制得到改善，但由于药物治疗和一般心理治疗未能终止呕吐发作，呕吐频率增加，导致出院困难并严重干扰日常生活。最终，采用了催眠疗法和微缩花园疗法，显著降低了呕吐频率，使其得以出院。在治疗这名1型糖尿病合并成人型周期性呕吐综合征的患者时，持续皮下胰岛素输注治疗和综合心理治疗是有效的。
