Bhatia E, Baijal S S, Kumar K R, Choudhuri G
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Diabetes Care. 1995 Aug;18(8):1174-8. doi: 10.2337/diacare.18.8.1174.
To compare the pancreatic exocrine and beta-cell function in the two variants of malnutrition-related diabetes mellitus (MRDM): fibrocalculous pancreatic diabetes (FCPD) and protein-deficient pancreatic diabetes (PDPD).
Fecal chymotrypsin (FCT) and fasting C-peptide levels were measured in 20 consecutive patients with FCPD and 19 with PDPD. FCPD was diagnosed by pancreatic calcification on ultrasonography, while the diagnosis of PDPD was made on the basis of low body mass index, severe diabetes requiring insulin therapy, and ketosis resistance on interruption of insulin. Twenty patients with type I diabetes and 32 healthy subjects served as control subjects.
Both FCPD and PDPD patients had diminished levels of FCT when compared with those of control subjects and patients with type I diabetes. However, FCT levels were significantly lower in subjects with FCPD (median 0.4 U/g, range 0-8.9 U/g), in comparison with those with PDPD (4.7 U/g, 0.6-40.5 U/g; P < 0.001). Of the FCPD patients, 13 of 20 (65%) had severe exocrine pancreatic deficiency (FCT < 1 U/g) vs. 3 of 19 (15.8%) PDPD subjects (P < 0.01). In comparison with control subjects, fasting serum C-peptide levels were significantly diminished in both MRDM groups. However, C-peptide levels in subjects with FCPD (mean +/- SE, 0.22 +/- 0.04 nmol/l) and PDPD (0.26 +/- 0.04 nmol/l) were comparable.
Among the two variants of MRDM, subjects with FCPD have severe pancreatic exocrine deficiency in comparison with those with PDPD, even though their C-peptide levels are comparably diminished. This suggests that the pathogenesis of these two entities may differ or that the genetic and/or environmental factors leading to exocrine damage are different.
比较营养不良相关性糖尿病（MRDM）的两种类型：纤维钙化性胰腺糖尿病（FCPD）和蛋白质缺乏性胰腺糖尿病（PDPD）的胰腺外分泌功能和β细胞功能。
对20例连续性FCPD患者和19例PDPD患者测定粪便糜蛋白酶（FCT）和空腹C肽水平。FCPD通过超声检查发现胰腺钙化来诊断，而PDPD的诊断基于低体重指数、需要胰岛素治疗的严重糖尿病以及中断胰岛素治疗时的抗酮症。20例1型糖尿病患者和32名健康受试者作为对照。
与对照受试者和1型糖尿病患者相比，FCPD和PDPD患者的FCT水平均降低。然而，FCPD患者的FCT水平（中位数0.4 U/g，范围0 - 8.9 U/g）显著低于PDPD患者（4.7 U/g，0.6 - 40.5 U/g；P < 0.001）。20例FCPD患者中有13例（65%）存在严重胰腺外分泌功能不全（FCT < 1 U/g），而19例PDPD患者中有3例（15.8%）（P < 0.01）。与对照受试者相比，两个MRDM组的空腹血清C肽水平均显著降低。然而，FCPD患者（均值±标准误，0.22 ± 0.04 nmol/l）和PDPD患者（0.26 ± 0.04 nmol/l）的C肽水平相当。
在MRDM的两种类型中，FCPD患者与PDPD患者相比存在严重的胰腺外分泌功能不全，尽管他们的C肽水平降低程度相当。这表明这两种疾病的发病机制可能不同，或者导致外分泌损伤的遗传和/或环境因素不同。
