营养性疾病

060753单纯性营养不良患儿胰腺内分泌功能的变化/刘文彬…∥实用儿科临床杂志.-2005,20(12).-1196~1197采用放免分析法测定单纯性营养不良(PEM)患儿及对照组儿童空腹和摄入液体试验餐后60min外周血胰岛素、胰高血糖素、生长抑素(SS)及血糖水平。结果:与对照组比较,观察组空腹及     

哮喘患儿血糖、胰岛素、胰高血糖素变化的意义

目的　探讨非急性发作期哮喘患儿血糖、胰岛素、胰高血糖素水平变化及长期吸入丙酸倍氯米松对其影响。方法　比较非急性发作期哮喘吸入激素治疗组、未吸入激素治疗组及对照组胰岛素、胰高血糖素水平 ,采用放射免疫分析法测定胰岛素、胰高血糖素水平。结果　未吸入激素的重度哮喘组胰岛素和血糖水平较其他组明显升高 (P均 <0 .0 5 ) ,胰高血糖素则明显减低 (P均 <0 .0 5 )。未吸入激素组、吸入治疗的轻中度哮喘组、正常对照组的糖耐量试验显示血糖和激素吸入量无显著差异 (P均 >0 .0 5 )。结论　非急性发作期重度哮喘患儿全身应用激素可能会引起机体血糖和相关激素代谢紊乱 ,从而加重哮喘和诱发糖尿病。     

新生儿缺氧缺血性脑病患儿生长抑素与细胞免疫功能的相关性

目的探讨新生儿缺氧缺血性脑病(HIE)患儿外周血生长抑素(SS)水平的变化及其与细胞免疫功能的关系。方法HIE新生儿50例血SS水平及T淋巴细胞亚群、IL-2、sIL-2R和IL-6分别采用放射免疫分析法、APAAP法和双抗体夹心ELISA法进行检测。并分析两者相关性。结果HIE患儿血SS水平明显高于对照组(P<0.01),其细胞免疫功能显示sIL-2R水平明显升高(P<0.01),而CD3 、CD4 百分率、CD4 /CD8 比值、IL-2及IL-6水平明显降低(P均<0.01)。HIE患儿血SS的变化与CD3 、CD4 百分率、CD4 /CD8 比值、IL-2及IL-6水平呈显著负相关(P均<0.01),与sIL-2R呈显著正相关(P<0.01)。结论HIE患儿血SS水平升高与HIE存在密切相关,且其变化与机体细胞免疫功能存在非常明显的相关性。     

哮喘患儿胰岛素、胰高血糖素和血糖水平测定

目的　 探讨不同哮喘状态下哮喘患儿的胰岛素、胰高血糖素和血糖水平及临床意义。 方法 　 5～ 12岁的儿童被选作研究对象 ,分为非急性发作期 4组和急性发作期 4组。应用放射免疫法测定上述儿童的胰岛素、胰高血糖素水平 ,氧化法测定血糖水平。结果进行方差分析。 结果 　非急性发作期正常对照、轻中度哮喘和缓解期 3组儿童的 3个检测指标之间无明显差别 ;而重度哮喘组胰岛素和血糖水平较其他 3组明显升高 ,胰高血糖素则明显减低。急性发作期正常对照、轻度哮喘组儿童的 3个检测指标之间无明显差别 ;而中、重度哮喘组胰岛素和血糖水平较其他两组明显升高 ,胰高血糖素则明显减低。 结论 　发作期中、重度哮喘的患儿在治疗过程中 ,可能会引起机体胰岛素和糖代谢紊乱 ,加重哮喘和诱发糖尿病。     

哮喘患儿胰岛素、胰高血糖素和血糖水平测定

目的 探讨不同哮喘状态下哮喘患儿的胰岛素、胰高血糖素和血糖水平及临床意义。方法 5－12岁的儿童被选作研究对象，分为非急性发作期4组和急性发作期4组。应用放射免疫法测定上述儿童的胰岛素、胰高血糖素水平，氧化法测定血糖水平。结果进行方差.分析结果 非急性发作期正常对照、轻中度哮喘和缓解期3组儿童的3个检测指标之间无明显差别；而重度哮喘组胰岛一不和血糖水平较其他3组明显升高，胰高血糖素则明显减低，急性发作期正常对照、轻度哮喘组儿童的3个检测指标之间无明显差别；而中、重度哮喘胰岛素和血糖水平较其他两组明显升高，胰高血糖素则明显减低。结论 发作期中、重度哮喘的患儿在治疗过程中，可能会引起机体胰岛素和糖代谢紊乱，加重哮喘和诱发糖尿病。     

围产期窒息对新生儿糖代谢影响的研究

为研究围产期窒息对新生儿血糖及其调节激素的影响,对40例窒息患儿生后72小时进行连续血糖监测,同时测定血清皮质醇(CT)、胰岛素(INS)、胰高血糖素(GC)和生长激素(GH)的浓度.结果显示,轻度窒息对新生儿糖代谢无影响;重度窒息生后6小时血糖最高,36小时最低(P＜0.01).4种激素水平明显增高(P＜0.01),多元线性回归分析发现重度窒息后6～12小时血糖值与CT和GC水平呈显著性正相关(P＜0.01),证实了新生儿重度窒息后高胰岛素血症和高血糖并存现象.结论认为,应激反应在新生儿重度窒息后高血糖的发生中起重要作用,血糖监测对重度窒息患儿十分重要,治疗时不宜应用糖皮质激素和胰岛素.     

围生期窒息对新生儿糖代谢影响

目的　研究围生期窒息对新生儿血糖及其调节激素的影响。方法　对 4 0例窒息儿生后 72h进行连续血糖监测 ,同时测定血清皮质醇 (CT)、胰岛素 (INS)、胰高血糖素 (GC)和生长激素 (GH)水平。结果　轻度窒息对新生儿糖代谢无影响 ;重度窒息生后 6h血糖最高 ,36h最低 (P <0 .0 1)。 4种激素水平明显增高 (P <0 .0 1) ,多元线性回归分析发现重度窒息 6～ 12h血糖与CT和GC水平呈显著正相关 (P <0 .0 1)。结论　应激反应对新生儿重度窒息后高血糖发生起重要作用 ,监测血糖对重度窒息患儿非常重要 ,治疗时不宜应用糖皮质激素和胰岛素。     

肥胖儿童伴良性黑棘皮病与胰岛素抵抗19例分析

目的　探讨肥胖儿童伴良性黑棘皮病与胰岛素抵抗及 2型糖尿病的关系。方法2 0 0 3年 6月～ 2 0 0 3年 9月 ,在我院内分泌门诊及病房就诊的体重指数 (BMI)≥ 2 5的肥胖儿童共 76例 ,对其中伴黑棘皮病皮肤改变的 19例 ( 2 5 % )均行皮肤病理活检以明确诊断 ,同时对这些患儿行空腹血糖、空腹血胰岛素水平、空腹血糖 /胰岛素比值 (FGIR)及人体测量学参数 [腰围 /臀围比值(WHR) ,全身体脂含量 (FM)、体脂百分数 (BF % )、体重指数 (BMI) ]等的检测 ,并行葡萄糖耐量试验(OGTT试验 ) ,以探讨肥胖儿童伴良性黑棘皮病与胰岛素抵抗及 2型糖尿病的关系。结果　 19例良性黑棘皮病患儿人体测量学参数包括腰围 /臀围比值 ,全身体脂含量 (FM)、体脂百分数 (BF % )、体重指数 (BMI)及空腹血胰岛素水平明显高于正常对照组 (P <0 0 1) ,空腹血糖 /胰岛素比值 (FGIR) ( 4 2 7± 0 5 3)小于 7,存在明显的胰岛素抵抗 ,其中 1例诊断为 2型糖尿病 ,10例有糖耐量异常。结论　儿童良性黑棘皮病与肥胖、高胰岛素血症 ,胰岛素抵抗及 2型糖尿病密切相关 ,是临床胰岛素抵抗的皮肤标志     

218例无追赶生长的小于胎龄儿儿童期糖代谢分析

目的 探索无追赶生长的小于胎龄儿在儿童期的胰岛素敏感性.方法 收集2008年8月至2016年8月于北京大学第三医院儿科门诊就诊的身材矮小患儿439例,分为小于胎龄儿组(small for gestational age,SGA)218例和特发性矮小组(idiopathic short stature,ISS)221例.比较两组之间的空腹胰岛素、空腹血糖、空腹血糖与胰岛素比值、胰岛β细胞功能(HOMA%)和胰岛素抵抗指数(HOMA-IR)特点.结果 两组患儿均根据青春期分期及性别分组,SGA组与ISS组,青春期前男性患儿的空腹血糖分别为(4.7±0.6)mmol/L和(4.8±0.6)mmol/L,P=0.678,空腹胰岛素(5.1±4.0)mU/L和(4.3±4.7)mU/L,P=0.345,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期前女性患儿的空腹血糖分别为(4.5±0.5)mmol/L和(4.6±0.5)mmol/L,P=0.828,空腹胰岛素分别为(4.7±3.5)mU/L和(4.5±3.3)mU/L,P=0.603,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期男性患儿的空腹血糖分别为(5.0±0.8)mmol/L和(4.9±0.5)mmol/L,P=0.176,空腹胰岛素分别为(5.9±4.3)mU/L和(6.0±4.5)mU/L,P=0.958,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期女性患儿的空腹血糖分别为(4.9±0.6)mmol/L和(4.8±0.4)mmol/L,P=0.141,空腹胰岛素分别为(7.5±6.4)mU/L和(7.4±8.6)mU/L,P=0.448,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义.     

慢性自身免疫性甲状腺炎患儿糖代谢临床研究

目的探讨慢性自身免疫性甲状腺炎(Hashimoto’sthyroiditis,HT)患儿的胰岛自身抗体及糖代谢的变化。方法通过对40例HT患儿的胰岛自身抗体(GAD、IA-2)、胰岛素、血糖水平的检测,与正常患儿相比较,探讨两者的相关性。结果40例HT患儿中,胰岛自身抗体GAD均阴性,有5例IA-2阳性,与对照组相比差异有显著性。餐后2h血糖、空腹胰岛素、餐后2h胰岛素均有升高,与对照组有显著变化。结论HT患儿有胰岛功能及胰岛自身抗体变化,提示有发展为多腺体自身免疫性疾病的可能。     

Postprandial glycaemia after regular and lispro insulin in children and adolescents with diabetes

We compared the postprandial blood glucose (BG)-levels following preprandial regular insulin or lispro insulin before and after eating in adolescents with diabetes. Lispro is a rapidly absorbed insulin analogue. Lispro insulin injected immediately before breakfast reduced the postprandial BG-rise significantly compared to the 20 min preprandially administered regular insulin (P<0.01). Postprandial lispro injection resulted in similar BG values as the standard treatment with regular insulin 20 min preprandially. Conclusion Lispro insulin injected immediately before the meal leads to lower postprandial BG levels and seems to be an option for teenagers who use multiple preprandial insulin injections. Postprandial lispro administration could be a benefit in certain situations since it resulted in similar BG values to preprandial regular insulin. Received: 13 March 1997 / Accepted: 26 May 1997     

脓毒性休克患儿血清皮质醇和促肾上腺皮质激素水平的变化及临床意义

目的 研究脓毒性休克（SS）患儿血清皮质醇和促肾上腺皮质激素（ACTH）水平的动态变化,探讨其与病情严重程度及预后的关系。方法 25 例SS 失代偿期及24 例SS 早期患儿纳入研究。检测患儿入院时、入院第3 天、入院第8 天的血清皮质醇和ACTH 水平。25 例健康体检小儿作为正常对照组。SS 失代偿期组患儿根据其转归分为死亡组（n=5）与存活组（n=20）两个亚组。结果 入院时SS 失代偿期组和SS 早期组血清皮质醇和ACTH 水平均明显高于正常对照组（P P P P P P 结论 SS 患儿血清皮质醇、ACTH 水平增高,其水平的增高与患儿病情有关,持续高水平的血清皮质醇提示预后差,因此,动态监测SS 患儿的血清皮质醇、ACTH 对判断病情的严重程度及预后具有较高的临床价值。     

Effects of feeding regimen on blood glucose levels and plasma concentrations of pancreatic hormones and gut regulatory peptides at 9 months of age: comparison between infants fed with milk formula and infants exclusively breast-fed from birth

Little is known about the development of gut endocrine responses to food intake in infants after the first postnatal month. To examine this question and to ascertain whether the mode of feeding from birth affects postprandial endocrine changes, blood glucose levels and the plasma concentrations of 11 regulatory peptides were measured at 9 months of age before and after a breast feeding in 13 exclusively breast-fed infants and before and after a formula feeding in 7 infants weaned during the first 3 months of life. In the prefeeding concentrations of these substances, no significant differences were found between the two groups, with the possible exception of the plasma concentration of pancreatic polypeptide (p = 0.06). Postprandially, the responses were significantly smaller in the breast-fed infants, whose plasma concentrations of insulin, gastric inhibitory polypeptide, pancreatic polypeptide, and cholecystokinin were lower than in the formula-fed infants. In addition, the overall level of the insulin-glucagon ratio was lower (p = 0.03) in the breast-fed infants. A difference in the opposite direction was observed for plasma gastrin levels. No significant differences appeared between the groups for blood glucose, or plasma glucagon, vasoactive intestinal polypeptide, motilin, enteroglucagon, secretin, or neurotensin concentrations after feeding. It is concluded that at 9 months of age, the gut regulatory responses to milk feeding are of lower magnitude than during the neonatal period, but even at this age the response patterns still depend on the mode of feeding.     

应激状态下危重症患儿胰岛功能及胰岛素抵抗指数的变化

目的探讨危重症患儿应激状态下糖代谢与胰岛功能及胰岛素抵抗指数(IR)的关系。方法应用放射免疫法对危重症(30例)和正常对照组(30例)测空腹血糖(FBG)、空腹胰岛素(FINS)、空腹C肽(FCP)、胰岛素敏感性指数(ISI)、IR和空腹细胞功能指数(FBCI)等参数,并进行统计学处理。结果观察组FBG与对照组比较有显著差异(P<0.001),观察组FINS 显著高于对照组(P<0.001),观察组FCP与对照组比较有显著差异(P<0.001);观察组FBCI与对照组比较无明显差异(P> 0.05);对照组ISI明显高于观察组(P<0.01);观察组IR明显高于对照组(P<0.01)。结论危重症患儿出现胰岛素抵抗,对胰岛素敏感性减低,IR增加,是危重患儿糖代谢紊乱的重要原因。     

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目的观察单纯性肥胖儿童和健康正常体重儿童血清脑源性神经营养因子(BDNF)质量浓度的差异,探讨BDNF与儿童肥胖及瘦素抵抗、胰岛素抵抗的关系。方法南京军区福州总医院儿科等于2004年5月至2005年5月应用酶联免疫法检测单纯性肥胖儿童(37例)和健康儿童(31例)血清BDNF质量浓度与胰岛素(INS)浓度,应用放射免疫法检测血清瘦素(LEP)质量浓度。比较两组儿童血清BDNF、INS、LEP的差异,分析血清BDNF质量浓度与血清LEP质量浓度和INS浓度的关系。结果(1)两组儿童的体重指数(BMI)、BDNF、INS及LEP均差异显著(BMI:F=175·05,P<0·01;BDNF:F=12·35,P<0·01;INS:F=21·71,P<0·01;LEP:F=48·89,P<0·01),肥胖组BMI、INS及LEP均明显高于健康组,而肥胖组BDNF明显低于健康组。(2)影响LEP的因素依次为BMI、丙氨酸转氨酶(ALT)、BDNF(R2=0·5946,F=0·31,P<0·01);影响INS的因素依次为BMI、BDNF(R2=0·2647,F=11·34,P<0·01)。去除BMI、ALT影响后,BDNF与LEP、INS负相关(BDNF与LEP:r=-0·2455,P<0·05;BDNF与INS:r=-0·2878,P<0·05)。结论(1)肥胖儿童血清BDNF缺乏,未发现“BDNF抵抗”的特点。(2)学龄前儿童血清LEP、INS受BMI影响最大,还受血清BDNF影响。BDNF是二者独立的负相关因素。     

Subtotal pancreatectomy for hypoglycemia due to congenital hyperinsulinism: long-term follow-up of neurodevelopmental and pancreatic function

Abstract: Objective: To evaluate neurodevelopmental status as well as endocrine and exocrine pancreatic function in children who have undergone subtotal pancreatectomy for hypoglycemia due to congenital hyperinsulinism. Patients and methods: Out of 15 identified patients, eight children (mean age 12.7 ± 0.8 yr) participated in detailed psychometric testing and studies assessing glucose homeostasis, secretion of proinsulin, insulin, glucagon and C‐peptide during a test meal. Additionally, a 24‐h fast, glucagon challenge test, 72‐h stool collection, and ultrasonography of the pancreatic remnant were performed. Results: Five of the 15 initially identified children had seizure disorders, including two with mental retardation. Diabetes developed in two of 15 children. All eight children investigated in the present study had evidence for attentional control impairment and 50% had subnormal intellectual functioning. Two had symptomatic hypoglycemia during the 24‐h fast, while one had an elevated fasting glucose concentration. Four children, including the latter patient, had proinsulin/insulin ratios resembling patients with type 2 diabetes. Exocrine pancreatic function was normal in all eight children. No correlation was found between pancreatic endocrine function and pancreatic remnant size, nor between multiple pre‐ and postoperative factors (i.e., age at diagnosis and surgery) and neurodevelopmental outcome. Conclusion: While severe mental retardation or diabetes occurred infrequently in our patient population compared with previous reports, all of the studied children had subtle anomalies in their cognitive performance tests and the majority had endocrine test results indicative of abnormal insulin secretion and stressed pancreatic β cells. Although partial pancreatectomy remains the treatment of choice after medical therapy fails, improved therapeutic means are necessary to achieve better clinical outcome.     

功能性消化不良患儿多导胃电与胃排空的关系研究

目的 探讨功能性消化不良(FD)患儿的胃电图异常与胃排空的相关性.方法 使用Polygraf ID 四导胃电分析系统和核素法固体胃排空测定51例FD患儿和25例健康体检儿童的胃电活动和胃排空情况.结果①FD组与对照组相比,正常慢波百分比(N%)明显低于对照组(P＜0.01);FD组患儿有较高的胃电异常发生率,主要表现为餐前餐后混合性胃电节律紊乱,共32例,占62.7%.②FD组与对照组相比,4个导联餐后/餐前功率比差异有统计学意义(P＜0.05),显示FD组餐后主功率不增加.③FD组患儿餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高;FD组患儿餐前、餐后慢波耦联率(%)分别为26.95±13.69,26.93±12.63,对照组为69.02±5.15,70.18±4.68,FD组慢波耦联率低于对照组(P＜0.01).④FD组患儿胃排空延迟占23.5%,经Logistic多因素相关分析胃排空延迟与餐前、餐后慢波耦联率存在负相关(偏回归系数分别为-0.513,-0.296).结论 FD患儿有较高的胃电异常发生率,主要表现为胃电节律紊乱和餐后主功率不增加,餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高,慢波耦联率降低;胃排空延迟与慢波耦联率存在负相关.提示胃电异常在FD的发病中有一定意义.     

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目的观察二甲双胍治疗对高胰岛素血症肥胖患儿血清脂源性激素脂联素、抵抗素、瘦素水平的影响。方法2004-01—2005-02将武汉市儿童医院和同济医院54例高胰岛素血症肥胖患儿分为轻、中度肥胖组及重度肥胖组,均以二甲双胍治疗12周,测量治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。结果治疗前轻、中度肥胖组和重度肥胖组高胰岛素血症患儿空腹血糖水平与健康对照组比较差异无显著性(P>0.05),血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA-IR)均高于健康对照组(P<0.01),脂联素水平明显低于健康对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01),轻、中度肥胖组及重度肥胖组血清瘦素水平分别由治疗前的(24.3±1.8)μg/L、(30.2±5.1)μg/L降低为治疗后的(19.6±6.3)μg/L、(24.7±5.3)μg/L,差异有统计学意义;抵抗素水平分别由治疗前的(16.5±6.0)μg/L、(22.3±5.2)μg/L升高为(22.0±5.1)μg/L、(30.6±11.7)μg/L,差异有统计学意义;轻、中度肥胖组和重度肥胖组血清脂联素水平治疗前分别为(8.4±3.2)mg/L、(6.5±1.2)mg/L,治疗后分别为(8.9±2.3)mg/L、(7.03±3.0)mg/L,治疗前后相比,P>0.05。体重指数(BMI)下降,但差异无显著性。结论二甲双胍能显著改善肥胖患儿胰岛素抵抗。降低血清瘦素水平可能是其改善胰岛素抵抗机制之一,但在对脂源性激素脂联素、抵抗素水平的改善上,有其局限性。     

Gastric emptying and postprandial glucose excursions in adolescents with type 1 diabetes

Because amylin is co-secreted with insulin from beta cells, patients with type 1 diabetes (T1DM) are deficient in both insulin and amylin. Amylin delays gastric emptying and suppresses glucagon in the postprandial period. Hence, we hypothesized that children with complication-naive T1DM have accelerated gastric emptying in response to a mixed meal because of amylin deficiency. Amylin, glucagon, insulin, glucose, and gastric emptying were measured in seven T1DM and in eight control subjects without diabetes. Subjects with T1DM had markedly elevated glucose concentrations when compared with controls (p < 0.0001). Amylin concentrations as predicted were lower in T1DM compared with those in controls (p < 0.0001). Insulin did not peak in the immediate postprandial period in T1DM when compared with controls (p < 0.0001). Glucagon concentrations did not significantly differ between groups. Interestingly, gastric velocity was delayed in patients with T1DM compared with controls (p < 0.01). In conclusion, subjects with T1DM do have amylin deficiency but this is not associated with accelerated gastric emptying as we had hypothesized but rather with delayed gastric emptying. Factors other than amylin play a role in control of gastric motility in T1DM. Subcutaneous insulin delivery fails to reach adequate concentrations in the postprandial period to curtail peak glucose concentration in T1DM.     

肥胖儿童血清抵抗素变化及其临床意义

目的 探讨饮食控制和运动疗法对肥胖儿章血清抵抗素水平的影响及其临床意义。方法 测定36例肥胖儿童饮食控制和运动治疗前后血清抵抗素、胆固醇（CHO）、甘油三脂（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹和葡萄糖耐量试验（OGTT）2小时血糖、胰岛素,计算胰岛素抵抗指数（HOMA-IR）。结果 肥胖儿童血清抵抗素水平显著高于对照组（P〈0．05）,并与OGTT2小时血糖、胰岛素呈正相关（P〈0．05）;经饮食控制和运动治疗后肥胖儿童血清抵抗素、体重、BMI、血清CHO、TG、LDL-C、空腹和OGTT2小时胰岛素、HOMA-IR显著低于治疗前（P〈0．05）,治疗前后空腹和OGTT2小时血糖差异无显著性（P〉0．05）。结论 肥胖儿童血清抵抗素水平升高,并与OGTT2小时血糖、胰岛素呈正相关,推测将来有可能以检测血清抵抗素水平来了解肥胖儿童有否存在糖耐量受损;饮食控制和运动疗法可使肥胖儿童血清抵抗素降低,胰岛素抵抗减轻。