Ten Years Review Of Type 1 Diabetes Mellitus In Children And The Clinical Value Of Interleukin-10 In Diabetic Ketoacidosis Of Childhood Type 1 Diabetes Mellitus

Objective:To review the incident status of childhood type 1 diabetes mellitus hospitalized in Children's Hospital of Zhejiang University School of Medicine from 1999 to 2009 and to explore the clinical value of IL-10 in diabetic ketoacidosis of childhood type 1 diabetes mellitus.Methods:Two hundred and sixty three cases of childhood type 1 diabetes mellitus in Children's Hospital of Zhejiang University School of Medicine were collected from Jan.4th,1999 to Feb.6th,2009.The genetic background,age distribution, gental composition,blood glucose,HbA1c,C-peptide,triglyceride,total cholesterol,ketoacidosis and PH level of these cases were analyzed retrospectively.TC,TG,IL-2,IL-4,IL-6,IL-10,TNF-α,IFN-γwere assessed in forty eight diabetic children and twenty four healthy children who were enrolled from Dec.2^nd,2006 to Feb.6^th,2009.Three subgroups were selected according to the diagnostic criteria:Groupl:type 1 diabetes mellitus with ketoacidosis;Group2:type 1 diabetes mellitus without ketoacidosis;Group 3:control group.TC,TG,cytokines were compared in these three groups.Results:1.The result shows female polarization.There were one hundred and forty eight(56.28%,148/263) female diabetic children and one hundred and fifteen (43.72%,115/263) male diabetic children.The ratio of male to female was 0.78:1.The peak incident age was at the year of 6 to 11.9(55.1%,145/263).There were forty three(16.34%,43/263) diabetic children with family history,and eighty two children(31.17%,82/263) complicated with infection.2.There were eighty six(32.7%,86/263)children with ketoacidosis when they were first admitted to our hospital.Among them,forty patients(46.51%,40/86) were complicated with infection(especially respiratory infection),thirty four (39.53%,34/86) with mild diabetic ketoacidosis,twenty five(29.07%,25/86) with moderate diabetic ketoacidosis,and twenty seven(31.40%,27/86) with severe diabetic ketoacidosis.Twenty seven diabetic children with severe ketoaicidosis (twelve of them with PH level below 7.0,and two of them with coma and convulsion),none of them died after effective therapy like active fluid infiltration and low-dose insulin therapy.3.The comparisons of two hundred and sixty one diabetic children:There were no differences in age,sex,and level of C-peptide between diabetic children with ketoacidosis and diabetic children without ketoacidosis(p＞0.05).The levels of TC,TG,blood glucose and HbA1c were significantly higher in diabetic children with ketoacidosis than those without ketoacidosis(p＜0.05).There were significantly negative correlations between PH and blood glucose(r=-0.373),as well as significantly positive correlations between blood glucose and HbA1c (r=0.373),TC and TG(r=0.523)(p＜0.01).And the increased levels of blood glucose,TC,TG and HbA1c were risk factors of diabetic ketoacidosis by Logistic analysis.4.The comparisons of 72 children with cytokines assessed:The level of serum IL-10 was significantly higher in diabetic children with ketoacidosis than those without ketoacidosis(p＜0.01),wheras,no differences were detected in IL-2,IL4,IL-6,TNF-α,IFN-γ.Serum IL-2,IL-4,IL-6,IL-10,TNF-α,IFN-γ,were significantly higher in diabetic children than those in healthy children(p＜0.01).PH had negative correlations with IL-10 and IL-6(r=-0.303,-0.587,p＜0.05).There were no correlations between cytokines and TC,TG,blood glucose,HbA1c,C-peptide (p＞0.05).Conclusions:1.Among those diabetic children hospitalized,the composition ratio was higher in female than in male,and the peak incident age was at the year of 6 to 11.9.The most common acute complications of type 1 diabetes mellitus was ketoacidosis,which was mainly induced by infection,And type 1 diabetes mellitus had inheritance tendency.2.There were disorders of glucose and lipid metabolism in diabetic children with ketoacidosis,which were the risk factors of ketoacidosis.And there were significant correlations between the levels of blood lipid and blood glucose.3.Serum IL-2,IL-4,IL-6,IL-10,TNF-α,IFN-γwere higher in diabetic children than those in healthy children.The level of serum IL-10 was significantly higher in diabetic children with ketoacidosis,and had negative correlation with PH,thus IL-10 may be a sensitive index of diabetic ketoacidosis in childhood type 1 diabetes mellitus.