【摘要】 目的  提高对DKA为初发表现的年轻超重/肥胖T2DM患者的认识，并探讨减少此种急症的措施。 方法  回顾性分析4例以DKA为首发表现的年轻超重/肥胖T2DM患者的临床特点并复习相关文献。  结果  4例患者均为年轻男性(年龄14~31岁)，有糖尿病家族史，长期大量饮用碳酸饮料的不良饮食史,长期超重/肥胖，均为急性起病（病程8~14 d），以DKA（pH 7.00~7.16）为首发表现，入院时胰岛功能差（FC-P 269.2~469.6 pmol/L），经治疗后胰岛功能迅速恢复，此后以生活方式干预联合二甲双胍治疗，血糖控制良好（HbA₁c 5.5%~6.3%）。 结论  在超重/肥胖的青少年人群中（特别是有糖尿病家族史）应积极筛查糖尿病，以减少DKA及其他糖尿病慢性并发症发生。

【关键字】糖尿病酮症酸中毒；糖尿病，2型；肥胖

Case Report of four overweight/obese young T2DM patients with serious diabetic ketoacidosis as initial manifestation and literature review GAO Cai-xia，LIU Yi-qiao，FENG Wen-huan, et al. Department of Endocrinology, Integrated Traditional Chinese and Western Medicine Drum Tower Hospital of Nanjing University of Chinese Medicine, Nanjing 210008, China

Corresponding author：FENG Wen-huan, E-mail：fengwh501@163.com.

【Abstract】  Objective  To improve the diagnosis and treatment of DKA as an initial manifestation in young overweight or obese T2DM patients in order to reduce the occurrence of such emergency.  Methods  Clinical characteristics of four overweight or obese T2DM patients with DKA as early manifestation were analyzed retrospectively, and related literature was reviewed.  Results  All four patients were young men(14~31years), with family history of diabetes, unhealthy diet history of too much carbonated drinking and being obese for a long time; acute onset(diseases duration 8~14 d), presenting as DKA(Arterial pH7.00~7.16) and poor islet function. However, their islet function recovered quickly after treatment and their blood glucose were controlled by lifestyle intervention and metformin treatment(HbA₁c 5.5%~6.3%). Conclusion  T2DM should be actively screened in overweight or obese adolescents, especially with family history of diabetes, to reduce the risk of DKA and other diabetic chronic complications.

【Key words】 Diabetic ketoacidosis（DKA）；Diabetes mellitus，type 2；Overweight/Obesity