北京大学学报(医学版) ›› 2024, Vol. 56 ›› Issue (5): 923-927. doi: 10.19723/j.issn.1671-167X.2024.05.027

• 病例报告 • 上一篇    下一篇

暴发性1型糖尿病合并急性胰腺炎1例及文献回顾

张培恒, 高莹, 吴红花, 张健*(), 张俊清   

  1. 北京大学第一医院内分泌科,北京 100034
  • 收稿日期:2021-07-30 出版日期:2024-10-18 发布日期:2024-10-16
  • 通讯作者: 张健 E-mail:zhangjian8971@163.com

Fulminant type 1 diabetes mellitus with acute pancreatitis: A case report and literature review

Peiheng ZHANG, Ying GAO, Honghua WU, Jian ZHANG*(), Junqing ZHANG   

  1. Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
  • Received:2021-07-30 Online:2024-10-18 Published:2024-10-16
  • Contact: Jian ZHANG E-mail:zhangjian8971@163.com

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关键词: 糖尿病,1型, 胰腺炎, 急性病

Abstract:

The objective was to report a relatively rare case of fulminant type 1 diabetes (FT1DM) complicated with acute pancreatitis (AP), to summarize the characteristics as well as experience of diagnosis and treatment, and to explore its pathogenesis. Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively. A 66-year-old male presented with acute fever and abdominal pain, accompanying with the significantly elevated pancreatic enzymes, and his abdominal CT scan showed exudation around the pancreas. The clinical manifestations mentioned above were consistent with the diagnosis of AP. Five days after onset, the patient developed clinical symptoms, such as obvious thirst, polyuria, polyasthenia and fatigue. Meanwhile, his plasma glucose increased significantly and the diabetic ketoacidosis (DKA) occurred. The patient's fasting and postprandial 2 hours C peptide decreased significantly (all 0.02 μg/L), glycated hemoglobin level was not high (6%), and his islet-related autoantibodies were undetectable. Thus, the patient could be diagnosed with FT1DM. After the treatment of fasting, fluid replacement, anti-infection, somatostatin, anticoagulation and intravenous insulin sequential subcutaneous insulin pump, the patient gained the alleviation of pancreatitis, restoration of oral intake, and relatively stable blood glucose levels. Summarizing the characte-ristics of this case and reviewing the literature, FT1DM complicated with AP was relatively rare in FT1DM. Its common characteristics were described below: (1) Most cases started with AP and the blood glucose elevated within 1 week, or some cases had the simultaneously onset of AP and FT1DM. (2) The clinical course of AP was short and relieved no more than 1 week; Pancreatic imaging could completely return to normal within 1 to 4 weeks after onset. (3) The etiology of AP most was idiopathic; The elevation of pancreatic enzyme level was slight and the recovery was rapidly compared with AP of other etiologies. FT1DM could be complicated with AP, which was different from the physiological manifestations of pancreatic disease in general FT1DM patients. Virus infection mignt be the common cause of AP and FT1DM, and AP might be the early clinical manifestation of some FT1DM. The FT1DM patients developed with abdominal pain was easy to be missed, misdiagnosed and delayed, which should receive more attention in clinic.

Key words: Diabetes mellitus, type 1, Pancreatitis, Acute disease

中图分类号: 

  • R587.1

图1

FT1DM合并AP患者起病时(2020-12-19)腹部CT"

表1

FT1DM合并AP患者胰腺功能相关指标的演变"

Items Date
2020-12-19 2020-12-20 2020-12-22 2021-01-05
FBG/(mmol/L) 5.2 5.6 19.7 6.2
C-peptide/(μg/L) ND ND < 0.01* 0.02*#
Amylase/(IU/L) 427 99 18 16
Lipase/(IU/L) >300 168 9 15
Fat drop or muscle fibers in stool ND ND ND ND

图2

FT1DM合并AP患者症状缓解时(2021-01-08)腹部CT"

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