Urakami Tatsuhiko, Yoda Midori, Yoshida Kei, Mine Yusuke, Aoki Masako, Suzuki Junichi
Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.
Pediatr Int. 2018 Jan;60(1):35-40. doi: 10.1111/ped.13456.
We conducted an annual urine glucose screening program at schools, and diagnosed schoolchildren with diabetes at an early stage of the disease. We also identified some cases of renal glucosuria (RG), based on positive urine glucose with normal glucose tolerance.
During 2000-2015, 3 309 631 schoolchildren participated in the screening program. The positive rate for glucosuria in the first test was approximately 0.1%, whereas on repeat urine test it was approximately 0.05%. In total 350 schoolchildren were positive for glucosuria on detailed examination. Oral glucose tolerance test (OGTT) was also used to evaluate glucose intolerance.
One hundred and two schoolchildren (29.7%) were diagnosed with diabetes, whereas RG was identified in 246 (70.3%) with normal glucose metabolism. In regard to the characteristics of RG, the percentage of boys was 50.3%, and the mean age at diagnosis was 11.2 ± 2.4 years. Twenty-eight children (11.4%) were overweight (body mass index standard deviation score [BMI-SDS] > +2.0 SD), whereas five (2.0%) were underweight (BMI-SDS < -2.0 SD). First-degree family history was suspected in 176 cases (71.5%). All RG subjects had normal glucose tolerance in the absence of insulin resistance and decreased insulin secretion (homeostasis model assessment for β-cell function, 78.8 ± 59.5%) on OGTT.
RG is not rare in Japanese schoolchildren with glucosuria. This disorder seems to have a strong genetic background, and to involve less growth retardation and weight loss than expected despite continuous excretion of glucose in urine.
我们在学校开展了年度尿糖筛查项目，以便在糖尿病发病早期诊断学童是否患有糖尿病。我们还根据尿糖阳性且糖耐量正常的情况，识别出了一些肾性糖尿（RG）病例。
在2000年至2015年期间，3309631名学童参与了筛查项目。首次检测时糖尿的阳性率约为0.1%，而重复尿检时约为0.05%。在详细检查中，共有350名学童尿糖呈阳性。口服葡萄糖耐量试验（OGTT）也用于评估葡萄糖不耐受情况。
102名学童（29.7%）被诊断患有糖尿病，而246名（70.3%）葡萄糖代谢正常的学童被诊断为肾性糖尿。关于肾性糖尿的特征，男孩的比例为50.3%，诊断时的平均年龄为11.2±2.4岁。28名儿童（11.4%）超重（体重指数标准差评分[BMI-SDS]> +2.0 SD），而5名（2.0%）体重过轻（BMI-SDS < -2.0 SD）。176例（71.5%）怀疑有一级家族病史。所有肾性糖尿患者在OGTT时糖耐量正常，不存在胰岛素抵抗且胰岛素分泌减少（β细胞功能稳态模型评估，78.8±59.5%）。
在日本尿糖阳性的学童中，肾性糖尿并不罕见。这种疾病似乎有很强的遗传背景，尽管尿液中持续排泄葡萄糖，但与预期相比，生长发育迟缓和体重减轻的情况较少。
