儿童青少年1型糖尿病体质指数变化及相关性分析

doi:10.12372/jcp.2023.22e0686

摘要/Abstract

摘要：

目的比较1型糖尿病（T1DM）患儿确诊时与末次随访时体重指数标准差积分（BMISDS），并揭示影响其变化的相关因素。方法回顾性分析2017年6月至2021年1月内分泌科收治的首次诊断T1DM患儿的临床资料。并分析各因素与ΔBMISDS的相关性。结果纳入T1DM患儿53例，男26例、女27例，中位随访病程为3.0（1.5~4.0）年。确诊时中位年龄8.0（5.5~11.0）岁，BMISDS为-1.1（-1.8~0.6），超重肥胖12例（22.6%）。至末次随访，42例完成随访，中位年龄12.0（8.8~13.3）岁，BMISDS为0（-0.6~0.7）；超重肥胖5例（11.9%）。末次随访时的BMISDS高于确诊时，差异有统计学意义（P<0.01）。确诊时非超重肥胖的患儿41例，30例完成随访，男14例，ΔBMISDS为0.3（-0.3~1.8），女16例，ΔBMISDS为1.9（1.1~2.2），女性的ΔBMISDS高于男性，差异有统计学意义（P<0.05）。0~5岁、5~10岁以及≥10岁组，女孩的ΔBMISDS均高于男孩，差异有统计学意义（P<0.05）。ΔBMISDS与确诊时BMISDS、空腹C肽（FCP）、游离三碘甲状腺原氨酸（FT₃）、游离甲状腺素（FT₄）、促甲状腺激素（TSH）呈显著负相关（P<0.05），与确诊时糖化血红蛋白（HbA1c）呈显著正相关（P<0.05）。在多元线性回归中ΔBMISDS与确诊时BMISDS、TSH依然呈显著负相关（P<0.05）。结论 T1DM患儿BMISDS在病程中呈现增加的趋势，与性别、确诊时BMISDS、TSH相关，应制定合适的干预措施，降低超重肥胖及其并发症的发生。

关键词: 1型糖尿病, 体质指数, 超重肥胖, 儿童青少年

Abstract:

Objective To compare the body mass index standard deviation scores (BMISDS) at diagnosis and last follow-up in children with type 1 diabetes mellitus (T1DM), and to reveal the related factors affecting the change of BMISDS. Methods The clinical data of children with T1DM initially diagnosed in the endocrinology department from June 2017 to January 2021 were retrospectively analyzed. The correlation between each factor and ΔBMISDS was analyzed. Results Fifty-three children with T1DM (26 boys and 27 girls) were included, and the median course of follow-up was 3.0 (1.5-4.0) years. The median age at diagnosis was 8.0 (5.5-11.0) years, the BMISDS were -1.1 (-1.8-0.6) and 12 patients (22.6%) were overweight and obese. Forty-two patients completed the last follow-up. The median age was 12.0 (8.8-13.3) years, the BMISDS were 0 (-0.6-0.7) and 5 patients (11.9%) were overweight and obese. The BMISDS at the last follow-up were higher than that at diagnosis, the difference was statistically significant (P<0.01). Of the 41 children who were not overweight and obese at the time of diagnosis, 30 completed the last follow-up. The ΔBMISDS of 14 boys and 16 girls were 0.3 (-0.3-1.8) and 1.9 (1.1-2.2), respectively. The ΔBMISDS of girls was higher than that of boys, and the difference was statistically significant (P<0.05). The ΔBMISDS of girls were higher than that of boys in 0~5 years old, 5~10 years old and ≥10 years old groups, and the difference was statistically significant (P<0.05). ΔBMISDS was significantly negatively correlated with BMISDS, fasting C-peptide (FCP), free triiodothyronine (FT₃), free thyroxine (FT₄) and thyrotropin (TSH) at diagnosis (P<0.05), and significantly positively correlated with glycosylated hemoglobin (HbA1c) at diagnosis (P<0.05). In multiple linear regression, ΔBMISDS was still significantly negatively correlated with BMISDS and TSH at diagnosis (P<0.05). Conclusions BMISDS in children with T1DM showed an increasing trend in the course of disease, which was related to gender, BMISDS and TSH at the time of diagnosis. Appropriate intervention measures should be developed to reduce the occurrence of overweight, obesity and its complications.

Key words: type 1 diabetes mellitus, body mass index, overweight and obesity, child and adolescent

赵玲, 刘晓静. 儿童青少年1型糖尿病体质指数变化及相关性分析[J]. 临床儿科杂志, 2023, 41(7): 519-525.

ZHAO Ling, LIU Xiaojing. Changes of body mass index and its related factors in children and adolescents with type 1 diabetes mellitus[J]. Journal of Clinical Pediatrics, 2023, 41(7): 519-525.

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项目	数值
确诊时
男[n(%)]	26(49.1)
初诊年龄[M(P₂₅~P₇₅)]/岁	8.0(5.5~11.0)
BMI[M(P₂₅~P₇₅)]/kg·m^-2	14.3(13.1~17.6)
BMISDS[M(P₂₅~P₇₅)]	-1.1(-1.8~0.6)
胰岛素剂量(x±s)/IU·kg^-1·d^-1	0.9±0.2
FCP[M(P₂₅~P₇₅)]/ng·mL^-1	0.3(0.1~0.4)
HbA1c(x±s)/%	12.8±2.3
FT₃(x±s)/pmol·L^-1	3.8±1.0
FT₄(x±s)/pmol·L^-1	16.2±3.9
TSH[M(P₂₅~P₇₅)]/μIU·mL^-1	2.2(1.6~3.4)
GADA阳性[n(%)]	5(9.4)
IA-2A阳性[n(%)]	3(5.7)
超重及肥胖[n(%)]	12(22.6)
末次随访¹⁾
年龄[M(P₂₅~P₇₅)]/岁	12.0(8.8~13.3)
中位随访病程[M(P₂₅~P₇₅)]/a	3.0(1.5~4.0)
BMI[M(P₂₅~P₇₅)]/kg·m^-2	17.8(15.8~20.1)
BMISDS[M(P₂₅~P₇₅)]	0(-0.6~0.7)
ΔBMISDS[M(P₂₅~P₇₅)]	0.8(-0.4~2.0)
胰岛素剂量[M(P₂₅~P₇₅)]/IU·kg^-1·d^-1	0.8(0.5~1.0)
FCP[M(P₂₅~P₇₅)]/ng·mL^-1	0.1(0.0~0.4)
HbA1c(x±s)/%	7.1±1.6
超重及肥胖[n(%)]	5(11.9)
胰岛素给药[n(%)]
CSII	6(14.3)
MDI	36(85.7)
血糖监测[n(%)]
CGM	20(47.6)
指尖血糖	22(52.4)

项目	分组	例数	ΔBMISDS	Z值	P
性别	男	22	0.3(-0.5~1.7)	1.74	0.082
	女	20	1.3(-0.1~2.2)	1.74	0.082
是否DKA	非DKA	21	0.3(-0.6~1.9)	1.12	0.263
	DKA	21	1.4(-0.1~2.0)	1.12	0.263
胰岛素给药方式	CSII	6	0.8(-0.7~1.9)	0.36	0.719
	MDI	36	0.8(-0.4~2.1)	0.36	0.719
血糖监测方式	CGM	20	1.2(-0.4~1.9)	0.08	0.940
	指尖血糖	22	0.3(-0.4~2.0)	0.08	0.940

年龄段	性别（n）	ΔBMISDS	Z值	P
0~5岁	男（4）	0.8(-0.1~1.0)	2.09	0.037
0~5岁	女（5）	1.3(0.9~1.6)	2.09	0.037
5~10岁	男（11）	0.6(-0.5~1.1)	2.29	0.022
5~10岁	女（10）	1.5(0.7~1.9)	2.29	0.022
≥10岁	男（7）	0.3(0.1~1.3)	2.03	0.048
≥10岁	女（5）	1.2(1.0~1.7)	2.03	0.048

项目	年龄	病程	确诊时							末次随访时
项目	年龄	病程	BMISDS	胰岛素剂量	FCP	HbA1c	FT₃	FT₄	TSH	胰岛素剂量	FCP	HbA1c
r值	-0.03	-0.23	-0.78	0.12	-0.32	0.34	-0.40	-0.38	-0.47	0.02	0.14	-0.14
P	0.874	0.148	<0.001	0.463	0.041	0.030	0.024	0.015	0.004	0.925	0.561	0.476

变量	偏回归系数	标准误	t值	P
确诊时BMISDS	-0.41	0.12	-3.49	0.002
确诊时TSH	-0.24	0.11	-2.30	0.029
常量	3.09	1.50	2.04	0.051