[Chronic pancreatitis and diabetes].
[Chronic pancreatitis and diabetes].
复制标题
[慢性胰腺炎与糖尿病].
作者：
P. Petrin;A. Chiappetta;G. Del Favero;R. Farini;S. Pedrazzoli
由于饮酒量的增加和诊断工具的改进，慢性胰腺炎的可能性似乎在增加。因此，慢性胰腺炎引起的糖尿病越来越受到重视。为了更好地了解这种特定的继发性糖尿病，我们对 1970 年至 1981 年间的 179 名慢性胰腺炎患者进行了研究。其中 154 名患者为男性，25 名女性。平均入院年龄为 45 岁，范围为 25 岁至 86 岁。所有患者均接受基于饮食、胰酶、疼痛控制的药物治疗。其中99人甚至接受了手术。随访时间从6个月到10年不等：在此期间18名患者死亡，41人失踪。 120名患者仍在观察中。 27名患者（15%）有糖尿病家族史。入院时，41 名患者 (23%) 出现高空腹血糖，其中 23 名患者甚至出现糖尿。其他74名患者进行了糖尿病口服葡萄糖耐量试验。在随访期间，27 人出现临床糖尿病，3 人因高渗性昏迷而死亡，8 人因糖尿病代谢失代偿而不得不多次重新入院。目前得到控制的120名患者中，66名（55%）出现空腹血糖异常，10名出现高血压，12名下肢血管病变伴感觉异常和间歇性跛行，2名心肌硬化和心房颤动，1名心肌梗死，2名慢性肾病，1名糖尿病视网膜病变。虽然手术或药物治疗可以缓解慢性胰腺炎的典型症状，但它们似乎对潜在的糖尿病无济于事。随着时间的推移，越来越多的患者出现葡萄糖不耐受，很早就开始依赖胰岛素，容易出现严重的糖尿病代谢失代偿，并可能出现血管、心脏或肾脏并发症。
Chronic pancreatitis appears to be increasing likely because increase in alcohol consumption and improved diagnostic tools. So the diabetes due to chronic pancreatitis is gaining importance. In order to obtain a better understanding of that particular secondary diabetes, 179 patients with chronic pancreatitis were studied from 1970 to 1981. 154 patients were male and 25 female. Average admission age was 45, ranging from 25 to 86. All the patients underwent medical therapy, based on diet, pancreatic enzymes, pain control. 99 of them underwent even to surgery. The follow-up is ranging from 6 months to 10 years: during this period 18 patients died, 41 went lost. 120 patients are still under observation. Diabetes was found in the family history of 27 patients (15%). At hospital admission 41 patients (23%) had high fasting glycemia, 23 of them even glycosuria. Other 74 showed diabetic oral glucose tolerance test. During the follow-up time 27 became clinically diabetic, 3 died because hyperosmolar coma and 8 had to be readmitted more than once because diabetic metabolic decompensation. Among the 120 patients at the moment under control, 66 (55%) show abnormal fasting glycemia, 10 developed high blood pressure, 12 inferior limbs vasculopathy with paresthesias and intermittent claudication, 2 myocardiosclerosis and atrial fibrillation, 1 myocardial infarction, 2 chronic nephropathy, 1 diabetic retinopathy. Whereas surgery or medic therapy may relieve chronic pancreatitis typical symptoms, they appear to be useless remedy against the under lying diabetes. As the time goes on more and more patients develop glucose intolerance, quite early became insulin-dependent, are disposed to severe diabetic metabolic decompensation and can show vascular, cardiac or renal complication.