青年起病非典型糖尿病的临床特征分析
Analysis of clinical characteristics in young-onset atypical diabetes mellitus

目的 探讨非典型糖尿病（ADM）青年患者的临床特征。方法 回顾性分析340例发病年龄≤40岁的糖尿病患者的病例资料。通过详细病史收集、体格检查及实验室检测，排除典型的1型糖尿病、2型糖尿病及其他类型糖尿病，共有20例患者符合ADM诊断标准。对该组患者的发病特点、胰岛β细胞功能变化及糖脂代谢指标进行分析。结果 在青年起病的ADM患者中， 男性多发（男∶女=18∶2）;且新诊断的糖尿病及家族史比例偏高，分别占80.0%和70.0%。ADM患者空腹及餐后2 h C肽均介于1型及2型糖尿病患者之间。此外，ADM患者的HbA1c及尿酸高于2型糖尿病患者（P=0.000, P=0.001），而三酰甘油高于1型糖尿病患者(P=0.002）。在6～12个月的随访过程中，19例患者（占95.0%）终止胰岛素治疗；其中12例患者（占60.0%）仅靠控制饮食及运动即可维持血糖水平正常。结论 青年ADM患者以男性多见，多为新诊断糖尿病患者且多有糖尿病家族史，常伴有脂代谢异常，胰岛β细胞功能修复能力较好。
： Objective To explore the clinical characteristics in youth patients with atypical diabetes mellitus (ADM). Methods Medical records of 340 diabetic patients with the age of onset ≤40 years were retrospectively analyzed. Typical type 1, type 2, and other types of diabetes were excluded via medical history collection, physical examination, and laboratory examinations. A total of 20 patients met the diagnostic criteria of ADM. Their onset characteristics, changes in islet β-cell function, and indexes for glucolipid metabolism were analyzed. Results The majority of young ADM patients were male (male female=18∶2). The percentages of patients with new-onset diabetes and a family history were high and accounted for 80.0% and 70.0%, respectively. Fasting C-peptide level and the C-peptide level 2 h after dinner in ADM patients were between those in patients with type 1 diabetes and type 2 diabetes. Besides, ADM patients had higher HbA1c and uric acid (UA) levels as compared with patients with type 2 diabetes (P=0.000, P=0.001) and higher triglyceride (TAG) level as compared with patients with type 1 diabetes (P=0.002). Nineteen patients (95.0%) stopped the insulin therapy during 6-12 months of follow-up. Among them, 12 (60.0%) were able to maintain the normal blood glucose just relying on diet and exercise. Conclusion The majority of young ADM patients are male. Most patients have new diagnosed diabetes and a family history. The lipid metabolism dysfunction is common in young ADM patients and their ability to repair islet β-cell function is favorable