儿童1型糖尿病胰岛素泵治疗长期随访的疗效观察

Long-term follow-up of efficacy of insulin pump in the treatment of children with type 1 diabetes mellitus

摘要:

目的 比较1型糖尿病（T1DM）患儿应用持续皮下胰岛素输注（CSⅡ）与每日多次皮下胰岛素注射（MDI）治疗对血糖控制的疗效差异。方法 回顾性收集91例应用CSⅡ方式治疗1年以上T1DM患儿的临床资料，评估其糖化血红蛋白（HbA1C）水平、糖尿病酮症酸中毒（DKA）再发生情况，通过与75例应用MDI治疗的T1DM患儿进行对比，评估两种治疗方式在随访3年中的效果差异。对CSⅡ组患儿及其家属进行满意度调查，了解应用胰岛素泵治疗的满意度情况。结果 CSⅡ组及MDI组在发病初期及随访第1年、第2年和第3年的年龄、性别、病程比较差异均无统计学意义（P > 0.05）。发病初期两组HbA1C水平比较差异无统计学意义（P > 0.05），随访第1年CSⅡ组HbA1C水平低于MDI组（P=0.04），随访第2年和第3年两组HbA1C水平比较差异均无统计学意义（P > 0.05）。随访第1年、第2年、第3年CSⅡ组HbA1C < 7.5%所占比例均高于MDI组，但差异均无统计学意义（P > 0.05）。随访3年内，CSⅡ组再发生DKA人数共2人，MDI组再发生DKA人数共8人。随访第3年，血压、血脂在CSⅡ组与MDI组间比较差异均无统计学意义（P > 0.05）。大部分患儿及家属（87%）对CSⅡ治疗满意。结论 应用CSⅡ治疗的T1DM患儿较MDI治疗患儿血糖水平控制更好，患儿及家属对应用CSⅡ治疗效果较满意，值得临床上推广应用。

Abstract:

Objective To study the clinical effect of continuous subcutaneous insulin infusion (CSII) versus multiple daily injection (MDI) on blood glucose control in children with type 1 diabetes mellitus (T1DM).Methods A retrospective analysis was performed on the medical data of 91 children with T1DM who were treated with CSII for more than 1 year and 75 children with T1DM who were treated with MDI.The two groups were compared in terms of glycosylated hemoglobin (HbA1C) and the recurrence of diabetic ketoacidosis (DKA) to evaluate the difference in the efficacy during the 3-year follow-up.A survey was conducted for the children in the CSII group and their family members to investigate the degree of satisfaction with insulin pump.Results There was no significant difference in age,sex,and course of diabetes between the CSII and MDI groups at disease onset and in the first year,the second year,and the third year of follow-up (P>0.05).There was no significant difference in the HbA1C level between the two groups at disease onset (P>0.05),but in the first year of follow-up,the CSII group had a significantly lower HbA1C level than the MDI group (P=0.04).There was no significant difference in the HbA1C level between the two groups in the second year and the third year of follow-up (P>0.05).The CSII group had a higher proportion of children with HbA1C<7.5% than the MDI group in the first year,the second year,and the third year of follow-up (P>0.05).Within the 3 years of follow-up,2 children in the CSII group and 8 in the MDI group experienced the recurrence of DKA.In the third year of follow-up,there was no significant difference in blood pressure and blood lipids between the CSII and MDI groups (P>0.05).Most children and their family members (87%) were satisfied with CSII treatment.Conclusions Children with T1DM treated with CSII have a better control of blood glucose than those treated with MDI,and children and their family members are satisfied with CSII treatment.Therefore,it holds promise for clinical application.