전격성 제1형 당뇨병 1예
A case of fulminant type 1 diabetes mellitus
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초록
Imagawa 등은 특발형 당뇨병 환자에서 임상경과가 매우 짧고 케톤산증과 같이 심각한 대사합병증을 동반하며 췌장효소수치가 높고 췌도 특이 자가항체 음성인 환자군을 새로운 아형으로서 전격성 당뇨병(fulminant type 1 diabetes)이라 하였다. 전격성 당뇨병의 발병기전은 비자가면역 기전에 의한 것으로 생각되나 아직은 논란의 여지가 있다.본 증례는 Imagawa가 제안한 기준과 유사한 전격성 당뇨병으로서 인플루엔자 유사증상과 위장관증상, 그리고 이에 동반된 고혈당과 케톤산증을 보였다. 환자의 당화혈색소는 정상이었고 인슐린과 C-펩티드 수치는 매우 낮았으며 항GAD항체가 참고치 이상으로 증가되어 있을 뿐 다른 췌도세포 특이항체는 음성이었다. 환자의 췌장효소수치는 정상이었다. 환자의 고혈당과 케톤산증은 수액과 인슐린 치료로 성공적으로 조절하였으며 환자는 인슐린 펌프로 치료 중이며 별다른 합병증 없이 외래 추적관찰 중이다.
Abstract
A novel subtype of type 1B diabetes with rapid onset and no evidence of autoimmunity has been recently proposed as fulminant type 1 diabetes. The pathogenesis of fulminant type 1 diabetes has not been fully understood. We report a case of fulminant type 1 diabetes with diabetic ketoacidosis. A 31-year-old male was referred to our hospital because of high plasma glucose level and acidosis. Laboratory findings were rendering a diagnostic picture of diabetic ketoacidosis with acute renal insufficiency. While there was high plasma glucose, normal HbA1c and other laboratory findings suggested a very recent onset of diabetes mellitus. A test to detect antibodies to islet cell antigen IA-2 was negative, but those of glutamic acid decarboxylase (GAD) was weakly positive. The patient successfully recovered without any serious complication after fluid and insulin based management.(Korean J Med 70:342-346, 2006)
참고문헌 (15)
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