Shiga Kentaro, Urakami Tatsuhiko, Suzuki Junichi, Igarashi Yasuhiro, Tajima Hanako, Amemiya Shin, Sugihara Shigetaka
Children's Medical Center, Yokohama City University Medical Center, Kanagawa 232-0024, Japan.
Department of Pediatrics, Nihon University School of Medicine, Tokyo 101-8309, Japan.
Endocr J. 2018 Aug 27;65(8):795-803. doi: 10.1507/endocrj.EJ18-0029. Epub 2018 May 22.
Fulminant type 1 diabetes mellitus (FT1DM) is a subtype of type 1 diabetes mellitus characterized by a remarkably abrupt onset. In Japan, FT1DM accounts for approximately 20% of acute-onset adult type 1 diabetes mellitus cases; however, reports of pediatric-onset FT1DM are rare. We aimed to determine the frequency and clinical characteristics of FT1DM in Japanese children and adolescents by conducting a 2-phase questionnaire survey among the members of the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) regarding their clinical experience with FT1DM. Responses were obtained from 54 of the 79 participating hospitals (68.4%). Of these, 8 hospitals managed a total of 15 pediatric patients with FT1DM (4 patients in each of 2 hospitals, 2 patients in 1 hospital, and 1 patient in each of 5 hospitals). The distribution of patient age was biphasic, with peaks in children younger than 5 years and older than 8 years of age. The clinical characteristics of FT1DM in this population (such as the duration from onset of symptoms to diagnosis, severity of symptoms, preceding flu-like episodes, and abnormal laboratory data) did not differ from those of patients with adult-onset FT1DM. The frequency of pediatric-onset FT1DM is low compared with that of adult-onset FT1DM. The genetic background and susceptibility patterns of pediatric patients with FT1DM may differ from those typical of adults with FT1DM, but both age groups share similar clinical characteristics.
暴发性1型糖尿病（FT1DM）是1型糖尿病的一种亚型，其特点是起病极为突然。在日本，FT1DM约占急性起病的成人1型糖尿病病例的20%；然而，儿童期起病的FT1DM报告却很少见。我们旨在通过对日本儿童和青少年糖尿病胰岛素治疗研究组（JSGIT）成员就其FT1DM临床经验进行两阶段问卷调查，来确定日本儿童和青少年中FT1DM的发生率及临床特征。79家参与调查的医院中有54家（68.4%）提供了回复。其中，8家医院共收治了15例儿童FT1DM患者（2家医院各有4例，1家医院有2例，5家医院各有1例）。患者年龄分布呈双峰型，在5岁以下和8岁以上儿童中出现峰值。该人群中FT1DM的临床特征（如从症状出现到诊断的时间、症状严重程度、前驱流感样发作及实验室数据异常等）与成人起病的FT1DM患者并无差异。儿童期起病的FT1DM发生率低于成人起病的FT1DM。儿童FT1DM患者的遗传背景和易感性模式可能与成人FT1DM患者不同，但两个年龄组具有相似的临床特征。
