| Objective:The clinical data of newly hospitalized children with T1DM in the department of endocrinology,genetics and metabolism of children's hospital of jiangxi province in recent 6 years were comprehensively analyzed,and the clinical characteristics were summarized and analyzed to provide a reference for the diagnosis and treatment of T1DM.Methods:From January 1,2013 to December 31,2018,a total of 184 patients with T1DM with the first onset were retrospectively analyzed.General information,clinical features and laboratory data of the patients were recorded in detail.Grouped by age:0-4 years old,5-9 years old,10-14 years old.All results were processed by SPSS 20.0software.The measurement data subject to normal distribution adopt single factor variance.The mann-whitney U test was used for measurement data that did not comply with normal distribution.The counting data were evaluated by chi-square test.Data subject to normal distribution were analyzed by Pearson correlation,while data not subject to normal distribution were analyzed by Spearman correlation.Results:1.General information:(1)age,gender,and regional distribution:in this study,there were 184 cases in total,and the number of cases in 2018 was 1.6 times that in2013.There were 92 cases of male and 92 cases of female,male:female=1:1.The age of onset ranged from 2 month to 13.58 years old,with an average age of7.15±3.53 years,and the peak age of onset was in the group of 5-9 years.There were90 cases in urban areas and 94 cases in rural areas,urban:rural=0.96:1,with 59%in nanchang,yichun and fuzhou.(2)Family history,feeding history and gestational age:33 cases(17.9%)had family history of diabetes.Breastfeeding 46.2%;Artificial feeding 42.9%;Mixed feeding was 10.9%.The first child in the family:53.3%;The second child in the family was 34.8%.(3)distribution of months of birth and visit:January,August and may had the largest number of births,while October had the least number of births,which showed no seasonal distribution.The most patients visited the hospital in March and November and January,and the least patients visited the hospital in June.There were 112 cases(60.8%)in winter and spring.There were53 cases(65.55%)in winter and spring.In the 0-4 years old group,30 cases(60.2%)were mainly distributed in spring and summer.The age group of 10-14 years old tended to be linear,and showed no obvious seasonal distribution.(4)comparison of general data of each age group:there was no statistical difference in gender,town,artificial feeding,family birth order,spring,summer,autumn,winter(P>0.05).In terms of breast-feeding,the differences were 28.3%,53.1%and 54%in groups 0-4years old,5-9 years old and 10-14 years old,respectively,P=0.008,and the differences were statistically significant.2.Laboratory data:(1)islet function series:INS decreased in 86 cases(47%);The C peptide reduced 139 cases(76%),and the GADA positive rate was 32%.The positive rate of IAA was 16%.There was no significant difference in the positive rates of GADA and IAA in each age group(P>0.05).(2)thyroid function series:FT3decreased in 71 cases(39%);FT4 decreased in 45 cases(24%).TSH decreased in 42cases(23%).The positive rate of ATG-Ab was 17%;The positive rate of TR-Ab was9%.The positive rate of TMA was 19%.There was no significant difference in the positive rates of ATG-Ab,TR-Ab and TMA among all age groups(P>0.05)(3)blood lipid series:TC increased in 24 cases(14%);TG increased in 106 cases(61%);FAA increased in 124 cases(75%);HDL decreased in 18 cases(10%);LDL increased in19 cases(10%).(4)Laboratory data of each age group were compared:GADA,IAA,ATG-Ab,TR-Ab,TMA,TG,LDL and FFA were not statistically significant(P>0.05).WBC,PH,FT4,TSH,HbA1C,INS,c-peptide,blood glucose,TC and HDL were significantly different in different age groups(P<0.05).Comparison between two groups:WBC:0-4 years old;>:5-9 years old;PH:>group aged 5-9years;HbA1C:10-14 years old>5-9 years old>0-4 years old;INS:10-14 years old group>5-9 years old group;C peptide:10-14 years old>group 5-9 years old,10-14years old>group 0-4 years old;Blood sugar:0-4 years old,>,5-9 years old;TC:5-9years old>0-4 years old;HDL;10-14 years old>0-4 years old;(5)correlation analysis:results of important indicators:blood glucose and blood gas are negatively correlated,r=-0.386,P<0.01;There was a positive correlation between blood glucose and triglycerides r=0.457,P<0.01.There was a positive correlation between blood gas and FT3,r=0.693,P<0.01.There was a negative correlation between blood gas and leukocyte,r=-0.607,P<0.01.3.Clinical data comparison:(1)hospitalization days,course of illness,chief complaint:the average hospitalization days showed a decreasing trend in each year.The difference in hospitalization days between different age groups was statistically significant,P<0.001,0-4 years old group>5-9 years old group?10-14 years old group?The time from symptom onset to diagnosis was the shortest(1 day)and the longest(365 days),with an average of 37.87±57.18 days.There was a statistically significant difference in the course of disease among age groups,P=0.026,and 0-4years old group<5-9 years old group.The onset symptoms and clinicalmanifestations of newly diagnosed diabetic children were varied,with drinking more and urinate more being the most common way of onset,with a total of 147 cases(80%).Among the non-diabetic symptoms,abdominal pain was the most common clinical manifestation in 50 cases(27%),followed by vomiting in 28 cases(15%)and mental distress in 19 cases(10%).(2)Diagnosis:125 cases(68%)of DKA were diagnosed.43cases(23%)were diagnosed with DK.T1DM was diagnosed in 16 cases(9%),and the incidence of DKA in each age group was 75%,61%,and 72%at the ages of 0-4,5-9,and 10-14,respectively,P=0.148,with no statistically significant difference.The incidence of severe DKA in each age group was 40%,20%and 39%,respectively,at the ages of 0-4,5-9 and 10-14,P=0.02,and the difference was statistically significant.(3)Misdiagnosis:there were 184 cases of misdiagnosis in 7 cases,the misdiagnosis rate was 3.8%,the average age was 4 years old,and the mean blood gas value was7.04.Mean WBC was 23.14×10~9/L.Mean blood glucose was 42.56mmolL.The average HbA1C was 8.6%?Conclusion:1?The infant group had the highest incidence of DKA and severe DKA,higher WBC and blood glucose,lower C peptide and pH,and shorter course of disease.The onset is rapid,the beta cell failure is more severe,and the hospital stay is longer.2?C peptide was higher in the adolescent group,the incidence of DKA and severe DKA was not low,and the incidence of HbA1C and LDL was higher,which should be paid attention to by clinicians.3?The change of WBC is negatively correlated with pH.When WBC is elevated but no infection lesion is found,no antibiotic treatment can be used to reduce the waste of medical resources.4?There was no gender difference in the newly diagnosed children,and the peak age was 5-9 years old.5?DKA is the most common onset of new children,mainly in winter and spring.6?The number of new arrivals in 2018 is 1.6 times that of six years ago,an increasing trend. |
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