妊娠初期に膵外分泌酵素上昇を伴う糖尿病ケトアシドーシスを発症したが, 短期間で耐糖能が正常化し正常分娩に至った1例 A Case of Recovery from a Fulminant Type 1 Diabetes Mellitus-like Episode During Pregnancy

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著者

    • 柴田 早織 SHIBATA Saori
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 岩瀬 正典 IWASE Masanori
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 藤井 裕樹 [他] FUJII Hiroki
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 中村 宇大 NAKAMURA Udai
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 佐々木 伸浩 SASAKI Nobuhiro
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 井元 博文 IMOTO Hirofumi
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
    • 飯田 三雄 IIDA Mitsuo
    • 九州大学大学院病態機能内科学 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University

抄録

症例は26歳女性.初回妊婦.2型糖尿病の家族歴あり.妊娠8週頃より妊娠悪阻が出現し,11週に突然口渇,全身倦怠感,軽度の意識障害が出現した.BMI 15.7 kg/m<sup>2</sup>, 血糖1,049 mg/d<i>l</i>, HbA<sub>1</sub>c 5.5%, 血中総ケトン体13,260 μmol/<i>l</i>, pH 7.282, BE-17.9 mmol/<i>l</i>, 糖尿病ケトアシドーシスと診断し,インスリン治療を開始した.抗GAD抗体陰性,1型糖尿病に関連するHLAなし.血清膵外分泌酵素が上昇していたが,膵炎を示唆する所見はなかった.その後血糖が低下し,インスリンを中止し得た.その時の75g OGTTは正常であった.妊娠週数が進んでも血糖は良好であり,妊娠39週で3,146 gの正常女児を経膣分娩した.妊娠中に劇症1型糖尿病類似の糖尿病ケトアシドーシスを発症したが,内因性インスリン分泌能は保たれており,短期間のインスリン療法後耐糖能正常となり,正常分娩に至った極めて稀な症例である.

A 26-year-old primipara with a positive family history of type 2 diabetes mellitus presented with abrupt onset of thirst, generalized malaise and slight disturbance of consciousness at 11 weeks of gestation. Her BMI was 15.7 kg/m<sup>2</sup>. Blood chemistry tests revealed a plasma glucose level 1,049 mg/d<i>l</i>, HbA<sub>1</sub>c of 5.5%, serum total ketone body level of 13,260 μmol/<i>l</i>; arterial blood gas analysis revealed a pH of 7.282 and BE of -17.9 mmol/<i>l</i>. The patient was diagnosed as having diabetic ketoacidosis and started on an intravenous infusion of insulin and saline. The patient tested negative for both anti-GAD antibody and the HLA haplotype associated with type 1 diabetes mellitus. However, the serum levels of exocrine pancreatic enzymes were elevated despite the absense of clinical findings of pancreatitis. After insulin therapy for 3 weeks, the blood glucose levels decreased, and the insulin therapy was discontinued. A 75-g OGTT revealed normal glucose tolerance. Glycemic control was well maintained by diet therapy alone until 39 weeks of gestation, when she delivered a healthy girl vaginally. While the clinical features in our patient resembled those of fulminant type 1 diabetes mellitus at the onset. Endogenous insulin secretion was preserved, and the glucose tolerance became entirely normal following short-term insulin therapy. Recovery from diabetic ketoacidosis during pregnancy is extremely rare.

収録刊行物

  • 糖尿病 = Journal of the Japan Diabetes Society  

    糖尿病 = Journal of the Japan Diabetes Society 50(1), 31-36, 2007-01-30 

    THE JAPAN DIABETES SOCIETY

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各種コード

  • NII論文ID(NAID)
    10018570382
  • NII書誌ID(NCID)
    AN00166576
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    0021437X
  • NDL 記事登録ID
    8687131
  • NDL 雑誌分類
    ZS21(科学技術--医学--内科学)
  • NDL 請求記号
    Z19-401
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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