儿童系统性红斑狼疮并发糖尿病临床特点及相关因素分析

doi:10.12372/jcp.2024.23e0068

摘要/Abstract

摘要：

目的分析儿童系统性红斑狼疮（SLE）并发糖尿病的临床特征，探讨SLE并发糖尿病的独立危险因素。方法选取2016年1月至2022年6月于肾脏内科住院的SLE并发糖尿病患儿为糖尿病组，同期住院未合并糖尿病的SLE患儿为对照组，收集两组患儿的临床资料，分析SLE并发糖尿病的危险因素。结果纳入SLE合并糖尿病患儿15例（7.4%），男5例、女10例。糖尿病中位发病年龄12.0（11.0 ~13.0）岁，发生糖尿病时SLE中位病程为25.5（11.5~92.5）天，中位空腹血糖为11.3（10.8~13.2）mmol/L。有糖尿病家族史6例。发生糖尿病时10例患儿足量激素（醋酸泼尼松2 mg·kg^-1·d^-1，最大量≤60 mg/d）使用中。对照组纳入SLE患儿151例（男42例、女109例）。与对照组比较，糖尿病组年龄较大，收缩压和舒张压较高，胆固醇、尿酸水平较高，高密度脂蛋白水平较低；收缩压异常升高，胆固醇、尿酸异常升高，高密度脂蛋白异常降低以及有家族史的患儿比例较高；尿蛋白转阴时间较长，差异均有统计学意义（P<0.05）。多因素logistic回归分析发现，年龄，糖尿病家族史，尿酸、胆固醇水平升高，高密度脂蛋白水平降低是SLE并发糖尿病的独立危险因素（P<0.05）。结论如SLE患儿年龄偏大，有糖尿病家族史，伴有高水平胆固醇、低水平高密度脂蛋白及高尿酸血症，需注意监测血糖，警惕继发性糖尿病的发生。

关键词: 系统性红斑狼疮, 糖尿病, 危险因素, 儿童

Abstract:

Objective To analyze the clinical characteristics of diabetes mellitus complicated by systemic lupus erythematosus (SLE) in children, and to explore the independent risk factors of diabetes mellitus complicated by SLE. Methods Children with SLE complicated with diabetes mellitus hospitalized in the Department of Nephrology from January 2016 to June 2022 were selected as the diabetes mellitus group, and children with SLE not complicated with diabetes mellitus hospitalized during the same period were selected as the control group, and the clinical data of the 2 groups were collected to analyze the risk factors of SLE complicated with diabetes mellitus. Results Fifteen children (7.4%) with SLE complicated with diabetes were included, 5 males and 10 females. The median age at onset of diabetes was 12.0 (11.0~13.0) years, the median duration of SLE at the time of diabetes was 25.5 (11.5~92.5) days, and the median fasting blood glucose was 11.3 (10.8~13.2) mmol/L. There were 6 cases with family history of diabetes. At the time of diabetes mellitus 10 children were on adequate hormone (prednisone acetate 2 mg·kg^-1·d^-1, maximum amount ≤60 mg/d) use. The control group included 151 children with SLE (42 males and 109 females). Compared with the control group, the diabetic group was older, had higher systolic and diastolic blood pressure, higher cholesterol and uric acid levels, and lower HDL levels; the proportion of children with abnormally high systolic blood pressure, abnormally high cholesterol and uric acid, abnormally low HDL, and a family history of SLE was higher; and the time for urinary protein to turn negative was longer, and the differences were all statistically significant (P<0.05). Multifactorial logistic regression analysis revealed that age, family history of diabetes mellitus, elevated levels of uric acid and cholesterol, and lowered levels of HDL were independent risk factors for diabetes mellitus complicating SLE (P<0.05). Conclusion If children with SLE are older, have a family history of diabetes mellitus with high levels of cholesterol, low levels of HDL and hyperuricemia, the occurrence of secondary diabetes should be alerted.

Key words: systemic lupus erythematosus, diabetes mellitus, child, risk factor

李志娟, 包瑛, 黄惠梅, 张敏, 王莹, 牛云鹤, 杨楠, 索磊, 梁楠. 儿童系统性红斑狼疮并发糖尿病临床特点及相关因素分析[J]. 临床儿科杂志, 2024, 42(5): 419-424.

LI Zhijuan, BAO Ying, HUANG Huimei, ZHANG Min, WANG Ying, NIU Yunhe, YANG Nan, SUO Lei, LIANG Nan. Clinical features and factors associated with diabetes mellitus in children-onset systemic lupus erythematosus[J]. Journal of Clinical Pediatrics, 2024, 42(5): 419-424.

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项目	糖尿病组(n=15)	对照组(n=151)	统计量	P
男性[n(%)]	5(33.3)	42(27.8)	χ²=0.21	0.651
年龄[M(P₂₅~P₇₅)]/岁	12.0(11.0~13.0)	10.0(8.0~12.0)	Z=2.87	0.004
BMI[M(P₂₅~P₇₅)]/kg·m^-2	18.2(17.7~19.6)	17.3(15.1~19.3)	Z=1.49	0.136
收缩压[M(P₂₅~P₇₅)]/mmHg	124.0(123.0~130.0)	106.0(100.0~112.0)	Z=5.03	<0.001
收缩压升高[n(%)]	5(33.3)	20(13.2)	χ²=4.30	0.038
舒张压[M(P₂₅~P₇₅)]/mmHg	78.0(76.5~91.0)	67.0(62.0~76.0)	Z=4.09	<0.001
舒张压升高[n(%)]	5(33.3)	23(15.2)	χ²=3.19	0.074
有糖尿病家族史[n(%)]	6(40.0)	15(9.9)	χ²=11.16	0.001
SLEDAI[M(P₂₅~P₇₅)]	18.0(13.0~20.0)	16.0(13.0~20.0)	Z=1.38	0.167
SLEDAI分级[n(%)]			-	0.565¹⁾
轻度	0(0)	3(2.0)
中度	5(33.3)	68(45.0)
重度	10(66.7)	80(53.0)
病理分级[n(%)]²⁾			-	0.139¹⁾
Ⅱ	0(0)	31(20.7)
Ⅲ	3(20.0)	31(20.7)
Ⅳ	12(80.0)	80(53.3)
Ⅴ	0(0)	8(5.3)

项目	糖尿病组(n=15)	对照组(n=151)	统计量	P
胆固醇[M(P₂₅~P₇₅)]/mmol·L^-1	6.6(4.9~8.4)	4.2(3.2~5.4)	Z=3.93	<0.001
胆固醇升高[n(%)]	8(53.3)	33(21.9)	χ²=7.27	0.007
高密度脂蛋白[M(P₂₅~P₇₅)]/mmol·L^-1	0.9(0.9~1.1)	1.2(1.0~1.3)	Z=3.12	0.002
高密度脂蛋白降低[n(%)]	9(60.0)	46(30.5)	χ²=5.37	0.020
尿酸[M(P₂₅~P₇₅)]/μmol·L^-1	678.0(358.0~851.0)	323.0(249.0~412.0)	Z=4.28	<0.001
尿酸升高[n(%)]	10(66.7)	46(30.5)	χ²=9.59	0.020
尿蛋白定量[M(P₂₅~P₇₅)]/mg·kg^-1·d^-1	49.0(16.8~118.5)	42.6(23.0~79.2)	Z=1.26	0.209
尿蛋白转阴例数[n(%)]	11(78.6)	138(91.4)	χ²=2.40	0.121
尿蛋白转阴时间[M(P₂₅~P₇₅)]/d	184.0(180.0~248.0)	55.0(21.0~104.0)	Z=3.70	<0.001

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
年龄	0.79	0.29	7.48	0.006	2.21(1.25~3.91)
收缩压升高	-0.13	0.88	0.02	0.883	0.88(0.16~4.94)
胆固醇升高	2.58	0.89	8.51	0.004	13.21(2.33~74.82)
高密度脂蛋白降低	2.52	0.88	8.20	0.004	12.41(2.21~69.53)
尿酸升高	2.02	0.88	5.25	0.022	7.50(1.34~42.11)
家族史	2.44	0.87	7.88	0.005	11.43(2.09~62.58)
常量	-22.45	5.82	14.87	<0.001	-