Alterations in monocyte receptor function in type 1 diabetic patients with ketoacidosis

The level of expression of three monocyte cell surface receptors was studied in seven patients with Type 1 (insulin-dependent) diabetes admitted to hospital with ketoacidosis. After recovery of metabolic control the monocyte carbohydrate-binding ('lectin-like') receptors that recognize bacterial cell wall sugars and receptors for complement components were reduced in the patients compared with normal control subjects. This was in contrast to the expression of the receptor for the Fc portion of immunoglobulin which remained unaltered. Compared with the control subjects the level of 'lectin-like' receptors was reduced by 22.8 +/- 6.5% (p less than 0.05) on admission to hospital and 12.1 +/- 1.7% (p less than 0.001) 6 weeks later when metabolic control had been established. The expression of complement receptors was 33.8 +/- 8.1% (p less than 0.01) lower than normal subjects when the diabetic patients suffered from ketoacidosis and 8.6 +/- 1.6% (p less than 0.01) lower than control subjects when patients had recovered metabolic control. The increased susceptibility to infection seen in diabetic patients, and the high incidence of infection in patients with ketoacidosis, may be partially the result of these changes in monocyte recognition mechanisms.     

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。     

The influence of hyperchloraemia on acid base interpretation in diabetic ketoacidosis

Objectives During the acute treatment of diabetic ketoacidosis we (a) determined the temporal incidence of hyperchloraemia, and (b) quantified the influence of hyperchloraemia on interpretation of common blood gas derived acid base parameters, namely base deficit and bicarbonate. Designand setting Retrospective chart review in two regional paediatric intensive care units. Measurements and Results Stewart's physicochemical theory was used to develop regression equations quantifying the acidifying effect of hyperchloraemia on both base deficit and bicarbonate. These were then applied retrospectively to blood chemistry results from 18 children (median age 12.7 years, weight 43 kg) with diabetic ketoacidosis. Plasma ketonaemia was estimated using the albumin-corrected anion gap. The incidence of hyperchloraemia, as documented by a ratio of plasma chloride to sodium of greater than 0.79, increased from 6% at admission to 94% after 20 h of treatment. Correction for chloride produced a dramatic improvement in the relationship between changes in the anion gap vs. both base deficit (from R ² = 0.55 to R ² = 0.95) and bicarbonate (from R ² = 0.51 to R ² = 0.96) during treatment. After 20 h of treatment the mean base deficit had decreased from 24.7 mmol/l to 10.0 mmol/l however, the proportion that was due to hyperchloraemia increased from 2% to 98%. Conclusions It is now possible using a simple correction factor to quantify the confounding effect of hyperchloraemia on both base deficit and bicarbonate in diabetic ketoacidosis. This bedside tool may be a useful adjunct to guide therapeutic interventions.     

儿童糖尿病酮症酸中毒的诊疗

在儿童糖尿病患者群中,1型糖尿病的发病率较高,且以酮症酸中毒（DKA）为首次发病常见,多种诱因可导致其发生。目前,DKA的反复发生对糖尿病患儿的生命健康构成严重威胁,本文分析DKA发生的诱因,对其诊断及治疗对策等方面进行概述。     

急诊糖尿病酮症酸中毒患者氧化应激水平的变化

目的初步探讨急诊糖尿病酮症酸中毒患者体内氧化应激的变化及其意义。方法将204例入选者分为健康对照组、单纯糖尿病组、慢性并发症组和酮症酸中毒组,分别测定总超氧化物岐化酶（T—SOD）,活力、丙二醛（MDA）含量和总抗氧化力（T—AOC）。结果与对照组相比较,单纯糖尿病组、慢性并发症组和酮症酸中毒组T—SOD活力和T—AOC明显降低（P〈0．01）,MDA含量明显升高（P〈0．01）。与单纯糖尿病组、慢性并发症组相比,酮症酸中毒组T—SOD活力和T—AOC明显降低（P〈0．01）,MDA含量明显升高（P〈0．01）。结论急诊糖尿病酮症酸中毒患者较无并发症或慢性并发症的糖尿病患者具有更高的氧化应激水平。     

中西医结合成功救治重症乳酸酸中毒并酮症酸中毒1例

运用中西医结合疗法,成功救治重症乳酸性酸中毒合并酮症酸中毒1例。     

糖尿病酮症酸中毒电解质紊乱预防及治疗

近几年儿童糖尿病发病率呈加速发展趋势,糖尿病合并酮症酸中毒的患儿尤其以酮症酸中毒为首发的患儿症状不典型,易误诊误治。在酮症酸中毒的诊治过程中存在比较严重而复杂的电解质紊乱,处理不当可能造成患儿出现严重的并发症如心率紊乱、脑水肿、猝死等。早期正确认识及时处理电解质紊乱对糖尿病酮症酸中毒的成功救治非常重要。