谷氨酸脱羧酶抗体和血、尿C肽检测在1型糖尿病中的意义

目的 探讨谷氨酸脱羧酶抗体(GAD_(65)-Ab)和血、尿C肽在1型糖尿病(DM)诊治和预后中的意义。方法 1型DM 23例,馒头餐试验检测胰岛功能,酶免法测定血清GAD_(65)-Ab,放免法测定血、尿C肽,进行有关临床特点分析,并与正常对照组比较。结果 与正常对照组比较,1型DM组GAD_(65)-Ab阳性率显著升高[分别为34.8％和0％,各时相血C肽和24 h尿C肽分泌总量明显低于正常对照组(P<0.01)];在1型DM组,与GAD_(65)-Ab阳性患儿比较,GAD_(65)-Ab阳性患儿发生酮症多、空腹C肽水平低和较多的胰岛素使用量(P<0.05)。结论 检测血清GAD_(65)-Ab和血、尿C肽对于1型DM的诊断、了解胰岛功能、指导治疗和判断预后均有重要临床意义。     

儿童1型糖尿病的抗体检测及临床意义

目的　了解胰岛细胞抗体 (ICA)和谷氨酸脱羧酶抗体 (GADA)阳性率与患儿胰岛功能的关系 ,明确ICA和GADA检测对 1型糖尿病的临床意义。方法　儿童 1型糖尿病 31例均采用ELISA法测定GADA ,间接免疫荧光法测定ICA ,化学发光法测定血清C肽、胰岛素 (DPC -IMMULITE机器 )。结果　ICA和GADA的阳性率分别为 4 5 .2 %和 38.7% ,儿童 1型糖尿病患者ICA阳性率高于GADA。抗体阳性患儿空腹和餐后C肽(0 .99± 0 .36ng/ml和 2 .10± 0 .99ng/ml)及餐后胰岛素 (11.5 3± 7.11μIU/ml)明显低于抗体阴性患儿空腹C肽 (2 .19± 1.33)ng/ml,餐后C肽 (6 .18± 3.91)ng/ml和餐后胰岛素 (18.6 0± 10 .5 9) μIU/ml,P <0 .0 5。结论　青少年糖尿病患者中ICA阳性率高于GADA。自身抗体阳性患儿胰岛功能明显低于阴性患儿 ,提示自身抗体阳性患儿胰岛功能损伤更明显。由于ICA、GADA两种抗体的阳性结果常不一致 ,联合检测可提高诊断率     

儿童1型糖尿病28例临床分析

目的 了解糖尿病儿童血糖及中远期并发症控制情况;探讨胰岛自身免疫性抗体在儿童1型糖尿病诊断中的作用。方法 用追踪调查法观察28例儿童1型糖尿病患儿。结果 糖尿病组与对照组谷氨酸脱羧酶抗体（GADA）,胰岛素自身抗体（IAA）,胰岛细胞抗体（ICA）三者联合检测阳性率比较均差异显著（P均＜0．05）;饮食控制组和一般控制组糖化血红蛋白值比较差异不显著（P＞0．05）,两者与不控制组比较有显著差异（P＜0．05）;三者空腹血糖值比较差异不显著（P均＞0．05）。结论 GADA、IAA、ICA均可作为儿童1例糖尿病诊断的指标。联合检测更具互补性。饮食控制能降低糖尿病患儿中远期并发症的发生。糖化血红蛋白则更能反映饮食控制情况。     

分型不明的婴幼儿糖尿病病因学探讨

目的探讨分型不明的婴幼儿糖尿病的病因。方法回顾分析2013年-2016年收治,3岁内起病的自身抗体阴性胰岛素依赖1型糖尿病(T1DM)患儿的临床资料。结果共收集19例患儿,男12例、女7例,起病年龄8个月～3岁;主要症状为乏力、消瘦、多饮、多尿;糖化血红蛋白8.6%～12%,合并酮症酸中毒14例;19例患儿的胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GAD65-Ab)、胰岛素抗体(IAA)均为阴性,胰岛素水平正常偏低。采用二代测序及甲基化MLPA方法检测28个糖尿病相关基因,2例患儿阳性;其中1例携带HNF1A c.1699GA,为已报道的杂合突变,来自其血糖正常的母亲;另1例携带CEL基因的c.2214delT,为尚未见报道的杂合突变,来自其空腹血糖正常的父亲。结论自身抗体阴性T1DM与单基因糖尿病之间存在交叉与重叠,二代测序对早期明确诊断有重要意义。     

儿童初发1型糖尿病与2型糖尿病的鉴别诊断

目的　探讨初发儿童 1型糖尿病 (DM)与 2型DM的鉴别诊断指标。方法　对 33例 1型DM患儿和 10例 2型DM患儿分别比较其糖尿病家族史 (FH)、发病年龄 (A)、发病至就诊时间 (T)、体重指数 (BMI) ,糖化血红蛋白 (HbA1c)、空腹血糖 (FPG)、餐后 2h血糖 (2hPG) ,空腹C 肽 (CP)、空腹胰岛素 (INS)、CP/FPG、INS/FPG ,馒头餐后血糖峰值 (PPG)、C 肽峰值 (PCP)、胰岛素峰值 (PINS)、PCP/CP、PCP/PPG、PINS/INS、PINS/PPG ,胰岛细胞抗体 (ICA)及谷氨酸脱羧酶抗体 (GAD) ,糖尿病酮症酸中毒控制后是否需胰岛素治疗。并设有关指标正常对照组。结果　 2型DM组FH阳性率显著高于 1型DM组 ;1型DM组A、T、BMI、CP、INS、CP/FPG、INS/FPG、PCP、PINS、PCP/CP、PCP/PPG、PINS/INS、PINS/PPG指标均显著低于 2型DM组 ,FPG、2hPG、HbA1c均显著高于 2型DM组 ,其中BMI、CP、CP/FPG、INS/FPG有明显的界值 ;2型DM10 0 %空腹胰岛素高于正常 ;ICA及GAD在 1型DM组阳性率显著高于 2型DM组 ;1型DM组全部需胰岛素维持治疗 ,2型不需用胰岛素维持治疗。结论　BMI、CP、INS、CP/FPG、INS/FPG及是否需胰岛素维持治疗是儿童 1型DM与 2型DM的诊断及鉴别诊断的简便、特异性指标 ;家族史、HbA1c、ICA、GAD是重要的参考指标 ;必要时做馒头餐后试验查     

儿童青少年糖尿病患儿胰岛功能及分型

目的研究儿童青少年糖尿病(diabetes mellitus,DM)患儿胰岛功能及分型.方法对56例DM患儿做胰高血糖素激发试验,其中C肽正常者1年后复查;以12例非DM患儿为对照.结果①DM组C肽基础值(BCP)、胰高血糖素刺激后C肽(PGCP)、C肽增高值(ICP)均低于对照组(P＜0.05).②C肽降低组(43例)BCP、PGCP、ICP均低于对照组(P＜0.05);C肽正常组(13例)BCP、PGCP与对照组差别无显著性,ICP低于对照组(P＜0.05).③C肽正常组10例复查激发试验,6例C肽降低,4例C肽正常.④经胰高血糖素激发试验,结合临床表现,诊断初发患儿C肽降低者为1型糖尿病,C肽正常者可能为2型糖尿病,但需随访胰岛功能,1年后C肽降低者仍为1型糖尿病.结论胰高血糖素激发试验能较好反映胰岛功能,有助儿童青少年糖尿病分型.     

儿童系统性红斑狼疮合并糖尿病4例及远期随访

目的 分析儿童系统性红斑狼疮(JSLE)合并糖尿病(DM)的临床特征并文献复习。方法 收集首都儿科研究所附属儿童医院2002至2008年收治的4例JSLE合并DM患儿的临床资料,总结其临床表现、治疗和预后。结果 4例女性患儿,3例12岁,1例8岁。4例患儿风湿免疫病相关自身抗体阳性,均确诊为JSLE;4例患儿多次查血糖升高,符合DM诊断;2/4例行胰岛素刺激试验和糖耐量试验,1例提示1型糖尿病可能性大,1例2型糖尿病可能性大;3/4例DM发病急剧,出现DM酮症酸中毒的临床表现。2例确诊为甲状腺功能减低。4例患儿均予糖皮质激素或添加免疫抑制剂治疗,狼疮活动均能缓解。1例患儿失访;3例患儿分别随访1、2和5年,其中2例长期应用胰岛素治疗,1例JSLE活动期予胰岛素治疗,病情稳定后通过控制饮食维持血糖正常;血糖均控制满意,生长发育正常。结论 DM可能JSLE的一种表现。糖皮质激素可能不是引起DM的主要原因。在治疗JSLE合并DM时,糖皮质激素是主要的治疗药物。JSLE患儿应及早预防DM的发生,除监测血糖和尿糖外,还应检测胰岛素自身抗体和谷氨酸脱羧酶抗体。     

1型糖尿病患儿血清素与C—肽水平的关系

为探讨1型糖尿病患儿血清瘦素与C－肽的相互关系，应用放射免疫分析的方法，检测65例1型糖尿病患儿和30例正常对照组血清中的瘦素和C－肽水平，结果：儿童1型糖尿病患儿与正常对照组血清中瘦素与C－肽水平比较差异有显著性（P＜0．01），32例患儿治疗前后瘦素和C－肽水平变化差异有显著性（P＜0．01），且瘦素和C－肽之间的变化呈正相关，瘦素／C－肽的比值与正常对照组及治疗后比较差异有显著性，提示：瘦素参于儿童1型糖尿病发病，瘦素水平的变化可能与1型糖尿病的发生，发展有密切关系。     

胰岛素泵治疗儿童1型糖尿病酮症酸中毒32例临床分析

目的 观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病酮症酸中毒(DKA)的疗效.方法 将2005-2008年收治的1型DKA患儿64例分为治疗组32例和对照组32例.治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注治疗.比较两组患儿血精变化、DKA纠正时间及住院时间.结果 治疗组血糖下降相对稳定,酸中毒纠正时间治疗组[(16.91±4.223)h]短于对照组[(23.31±3.797)h](P<0.001),且无反复.治疗过程中治疗组未出现低血糖,对照组出现1例.住院时间治疗组[(15.63±2.458)d]短于对照组[(20.88±3.348)d](P<0.001).结论 胰岛素泵持续皮下注射胰岛索治疗儿童1型糖尿病酮症酸中毒安全有效.     

不同体重指数糖尿病患儿胰岛自身抗体检测意义初探

通过对儿童糖尿病患儿检测谷氨酸脱羧酶抗体（GADA）、胰岛素自身抗体（IAA）、胰岛细胞抗体（ICA），旨在了解其在不同体重指数（BMI）糖尿病患儿中的差异，并初步探讨其意义。应用酶联免疫吸附法（ELISA）测定32例糖尿病患儿血清GADA、IAA、ICA。结果显示，132例糖尿病儿童中肥胖占31．2％，正常体重占6．3％，体重减轻占62．5％；肥胖儿GADA、ICA阳性率与体重减轻儿比较差异有显著性（P＜0．05），而IAA差异不显著（P＞0．05）；病程1年内的初发糖尿病中，肥胖儿GADA、ICA阳性率明显低于体重减轻儿。提示肥胖儿童糖尿病具有2型糖尿病的免疫学特征，随儿童糖尿病中肥胖儿的增多，2型糖尿病有增多趋势；相对IAA，检测GADA、ICA更适用于1、2型糖尿病的分型。     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.