Histopathology of the pancreas in fulminant type 1 diabetes after 23-year follow-up : a case report
Histopathology of the pancreas in fulminant type 1 diabetes after 23-year follow-up : a case report
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23 年随访后暴发性 1 型糖尿病胰腺的组织病理学：病例报告
DOI：
10.1111/pin.12017
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发表时间：
2012
影响因子：
2.2
通讯作者：
Miura T
中科院分区：
文献类型：
--
作者：
Sato T;Miki T;Murakami N;Hirohashi Y;Kouzu H;Furuhashi M;Tanno M;Yuda T;Saitoh S;Hasegawa T;Miura T
暴发性1型糖尿病（T1 DM）的特征是由于胰腺β细胞破坏导致的高血糖症和酮症/酮症酸中毒的快速进展，自2000年以来已被确定为特发性T1 DM的一种亚型。1暴发型T1 DM在发病后短期内的临床结局和胰腺组织学已有报道;然而，慢性期的临床结局和胰腺组织学尚不清楚。2，3本文报告一例暴发型T1 DM发病23年后的尸检病例。一位58岁女性糖尿病患者因抑郁症恶化后食欲不振而入院。她在35岁时开始患糖尿病，当时她妊娠33周，她的妊娠临床过程一直很顺利，直到突然出现高血糖症（> 300 mg/dl）和酮症伴流感样症状。她在糖尿病发作时的血红蛋白（Hb）A1 c（NGSP）水平为6.9%，尿C肽排泄量低于10 µg/天。尽管抗胰岛细胞抗体（ICAAb）为阴性，但由于胰岛素依赖状态，当时诊断为特发性T1 DM。此后进行了多次抗谷氨酸脱羧酶抗体（GADAb）和抗胰岛素瘤相关抗原-2抗体（IA-2Ab）检测，但所有结果均为阴性。39岁时，她患上了抑郁症，这大大减少了她的体力活动。她的血糖控制不佳（HbA 1c：8 ± 11%），并且反复发生感染。入院前一年，她被诊断为无症状性心肌缺血和外周动脉疾病，接受血管内血管成形术治疗。
Fulminant type 1 diabetes mellitus (T1DM), characterized by extremely rapid progression of hyperglycemia and ketosis/ketoacidosis due to destruction of pancreatic β-cells, has been established as a subtype of idiopathic T1DM since 2000. 1 Clinical outcomes and pancreas histology of fulminant T1DM during short periods after its onset have been reported; however, those in the chronic phase remain unclear. 2, 3 Here, we report an autopsy case 23 years after the onset of fulminant T1DM.A 58-year-old diabetic female was admitted to our institute because of appetite loss after deterioration of depression. Onset of her diabetes was at the age of 35 years, when she was at 33 weeks of gestation, and the clinical course of her pregnancy had been uneventful until the sudden development of hyperglycemia (> 300 mg/dl) and ketosis with flu-like symptoms. Her hemoglobin (Hb) A1c (NGSP) level at the onset of diabetes was 6.9% and her urinary C-peptide excretion was less than 10 µg/day. Although anti-islet cell antibody (ICAAb) was negative, diagnosis of idiopathic T1DM was made at that time because of the insulin-dependent state. Tests had since been conducted several times for antiglutamic acid decarboxylase antibody (GADAb) and antiinsulinoma-associated antigen-2 antibody (IA-2Ab), but all of the results were negative. At 39 years of age, she developed depression, which considerably reduced her physical activity. Her blood glucose control had been poor (HbA1c: 8∼ 11%) and she had repetitive infection episodes. One year before admission, she was diagnosed as having silent myocardial ischemia and peripheral arterial disease, which were treated by intravascular angioplasty.