Bhisitkul D M, Vinik A I, Morrow A L, She J X, Shults J, Powers A C, Maclaren N K
Division of Pediatric Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA.
Arch Pediatr Adolesc Med. 1996 Sep;150(9):936-41. doi: 10.1001/archpedi.1996.02170340050010.
Previous studies have shown that children with stress hyperglycemia have an increased risk for development of type I or insulin-dependent diabetes mellitus.
To determine whether stress hyperglycemia in prospectively screened pediatric patients represents a prediabetic state.
Prospective, cohort analytic study.
The Children's Hospital of the King's Daughters is an urban pediatric emergency department at a tertiary care, university-based children's hospital in Norfolk, Va.
All patients who required a venipuncture for evaluation of an acute illness or injury from October 1992 through March 1993 were screened prospectively for hyperglycemia (blood glucose level > or = 8.3 mmol/L [> or = 150 mg/dL]). Each hyperglycemic patient was age matched to a stress control subject (defined as a nonhyperglycemic but acutely ill child) from the emergency department and a healthy control subject from a well-child clinic.
Blood samples were obtained at the time of initial evaluation in the emergency department from 30 hyperglycemic patients (age range, 4 weeks to 12.4 years; median, 2 years), 30 stress control subjects, and 30 healthy control subjects. All samples were tested for islet cell antibodies, insulin autoantibodies, glutamic acid decarboxylase (GAD) antibodies, and HLA typing, specifically the genotypes at the DQB1 gene.
The presence of immunologic or genetic markers for insulin-dependent diabetes mellitus and/or the clinical development of insulin-dependent diabetes mellitus.
No patients or control subjects were positive for islet cell antibodies. One hyperglycemic patient and 3 stress control subjects were positive for insulin autoantibodies; all 4 of these subjects had sickle-cell disease and fever. Four of the 8 patients with sickle-cell disease had insulin autoantibodies, compared with none of the 52 patients and stress control subjects without sickle-cell disease (P < .001). One healthy control subject had antibodies to GAD65. The patient group did not show increased genotypes at the DQB1 gene that were indicative of an enhanced risk for insulin-dependent diabetes mellitus. Of the 32 hyperglycemic patients, 27 healthy control subjects, and 25 stress control subjects contacted for follow-up at 31 to 36 months, none has developed insulin-dependent diabetes mellitus.
Children with stress hyperglycemia do not have an increased prevalence of immunologic or genetic markers of insulin-dependent diabetes mellitus and thus do not appear to be at an increased risk for development of insulin-dependent diabetes mellitus. Our data suggest that insulin autoantibodies develop in children subject to sickle cell crises.
既往研究表明，应激性高血糖患儿患I型或胰岛素依赖型糖尿病的风险增加。
确定前瞻性筛查的儿科患者中的应激性高血糖是否代表糖尿病前期状态。
前瞻性队列分析研究。
国王女儿儿童医院是弗吉尼亚州诺福克市一家基于大学的三级医疗儿童医院的城市儿科急诊科。
1992年10月至1993年3月期间因急性疾病或损伤需要静脉穿刺评估的所有患者均接受前瞻性高血糖筛查（血糖水平≥8.3 mmol/L[≥150 mg/dL]）。每例高血糖患者均与急诊科的应激对照对象（定义为非高血糖但急性患病儿童）以及健康儿童门诊的健康对照对象进行年龄匹配。
在急诊科初次评估时，采集30例高血糖患者（年龄范围4周至12.4岁；中位数2岁）、30例应激对照对象和30例健康对照对象的血样。所有样本均检测胰岛细胞抗体、胰岛素自身抗体、谷氨酸脱羧酶（GAD）抗体以及HLA分型，特别是DQB1基因的基因型。
胰岛素依赖型糖尿病的免疫或遗传标志物的存在情况和/或胰岛素依赖型糖尿病的临床发病情况。
没有患者或对照对象胰岛细胞抗体呈阳性。1例高血糖患者和3例应激对照对象胰岛素自身抗体呈阳性；这4例对象均患有镰状细胞病并发热。8例镰状细胞病患者中有4例胰岛素自身抗体呈阳性，而52例无镰状细胞病的患者和应激对照对象均无阳性（P<0.001）。1例健康对照对象有GAD65抗体。患者组在DQB1基因上未显示出增加的基因型，这些基因型表明胰岛素依赖型糖尿病风险增加。在31至36个月时联系进行随访的32例高血糖患者、27例健康对照对象和25例应激对照对象中，无一人发生胰岛素依赖型糖尿病。
应激性高血糖患儿胰岛素依赖型糖尿病的免疫或遗传标志物患病率未增加，因此患胰岛素依赖型糖尿病的风险似乎未增加。我们的数据表明，患镰状细胞危象的儿童会出现胰岛素自身抗体。
