急性期に心電図上ST上昇と心筋逸脱酵素の上昇を認めた劇症1型糖尿病の1例

A Case of Fulminant Type 1 Diabetes Mellitus with ST-elevation on Electrocardiograms and Increase of Serum Creatine Phosphokinase

要旨　患者は54歳，男性，特記すべき既往歴はない．1週間前より全身倦怠感と多尿を自覚するようになり，徐々に嘔気も強くなり食事もとれなくなったため当院救急外来を受診した．随時血糖961mg/dl，尿ケトン体強陽性，動脈血pH7.144であり，糖尿病性ケトアシドーシスと診断し入院となった．HbA₁C6.0%，尿中CPR3.3μg/day，糖尿病関連自己抗体は陰性であり，劇症1型糖尿病と診断した．血糖や自覚症状は改善傾向であったが，第2病日突然の胸部圧迫感とともに心電図上ST上昇を認めた．急性心筋梗塞を疑い緊急心臓カテーテル検査を施行したが，冠動脈には狭窄，閉塞，血栓像はなく左室造影でも異常を認めなかった．心電図変化出現時は高血糖や代謝性アシドーシス，高カリウム血症は改善していたが，血清リン値が低値であった．本症例のST上昇と心筋逸脱酵素上昇の原因として低リン血症が疑われた．

　A 54-year-old man visited our hospital with symptoms of general fatigue, thirst, nausea and polyuria for 7 days. High plasma level of glucose 961 mg/dl, positive urinary ketone body, hyperkalemia and low level of arterial blood pH 7.144 revealed his diabetic ketoacidosis. Slight elevation of plasma level HbA₁c 6.0%, urinary C-peptide reactivity 3.3 μg/day and negative results of diabetes-related antibodies were signs leading to the diagnosis of fulminant type 1 diabetes. On the second hospital day he presented with chest pain and ST-T changes in leads II, III, aVF and V_3-6 on the electrocardiogram. Data of blood sugar, potassium and arterial pH were close to the normal levels, but high levels of serum creatinine phosphokinase and hypophosphatemia were detected. Neither stenosis nor occlusion was found in his coronary angiography, and the left ventricular wall motion was normal.

　We considered the strong relationship between hypophosphatemia and myocardial damage during management of his fulminant type 1 diabetes.