饮食干预管理和健康教育对糖尿病酮症酸中毒患者健康情况的影响

目的探讨饮食干预管理和健康教育对糖尿病酮症酸中毒患者健康情况的影响。方法选取台州市恩泽医疗中心(集团)路桥医院2015年1月—2017年1月间接收的76例糖尿病酮症酸中毒患者作为此次研究对象,按照随机数字表法将患者分为对照组与研究组各38例。对照组患者给予常规护理,研究组患者则强化个体化饮食干预管理和健康教育。对2组患者治疗情况(24 h血糖最大值、血糖控制时间、酮体转阴时间、住院时间)、健康知识水平(发病原因、防治方法、饮食、运动)、健康饮食依从性、满意度进行比较。结果研究组24 h血糖最大值、血糖控制时间、酮体转阴时间、住院时间明显低于对照组,差异有统计学意义(P<0.05)。干预后,2组健康知识水平(发病原因、防治方法、饮食、运动)、健康饮食依从性评分显著提高,且观察组健康知识水平(发病原因、防治方法、饮食、运动)、健康饮食依从性评分显著高于对照组(P<0.05)。研究组患者满意度明显高于对照组,差异有统计学意义(P<0.05)。结论饮食干预管理和健康教育在糖尿病酮症酸中毒患者中应用效果显著,有效缩短患者病情好转时间,提高患者健康知识掌握水平、健康饮食依从性、护理满意度。     

Rhino-orbital-cerebral mucormycosis in type 1 diabetes mellitus

AIM : To describe the presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) in adolescents with type 1 diabetes mellitus (T1 DM).Methods : the medical records of six patients of T1 DM with ROCM admitted between October 2001 to January 2004 were analysed.Results : the mean (± SD) age and duration of DM of these patients were 16.1 ±3.0 years and 26.3 ± 24.9 months respectively. Four patients had ROCM at presentation, while two developed it during their hospital stay when recovering from diabetic ketoacidosis. Proptosis (100%) and ptosis (100%) were the most common symptoms, and ophthalmoplegia (85%) and vision loss (85%) were the most common signs. Maxillary sinus (85%) was the commonest paranasal sinus to be involved. All patients received amphotericin B and had appropriate surgery except one. Four patients survived. Patients who had altered sensorium, facial necrosis, palatal perforation and cerebral involvement at presentation had poor outcome.Conclusion : High index of suspicion of ROCM in T1 DM and combined approach with amphotericin B and appropriate surgery is rewarding.     

Recent advances in management of diabetic ketoacidosis

Diabetic ketoacidosis is the most common endocrine emergency in children and frequently it is the initial presentation of insulin dependent diabetes mellitus. Despite sophisticated technology and our improved understanding of the pathophysiology of this disease, the mortality from intracranial complications remains constant over the past two decades. Several management protocols are used all over the world but the recent trend in opinion seems to be one of the slower rates of initial hydration aimed at matching the osmolarity of the infusion solutions with the patient's serum osmolarity. It remains to be seen if widespread use of this rehydration strategy will improve morbidity in the future. A protocol for managing diabetic ketoacidosis is suggested.     

儿童1型糖尿病的10年回顾及白介素-10在糖尿病酮症酸中毒中的临床意义

目的：回顾浙江大学医学院附属儿童医院10年来住院儿童 1 型糖尿病的发病状况并探讨白介素-10（IL-10）在儿童 1 型糖尿病酮症酸中毒（DKA）中的临床意义。方法：对1999年1月至2009年2月在该院住院的263例334例次1型糖尿病患儿的临床资料进行回顾性分析;并对其中48例1型糖尿病患儿进行血脂、细胞因子等检查,根据有无酮症酸中毒分为 DKA组和非DKA组,24例正常健康儿童作为对照组,比较各组间血脂、细胞因子等参数的差异。结果：儿童1型糖尿病患儿中,女性多见（56.3%）,发病年龄以6~11.9岁多见。32.7% 的患儿以酮症酸中毒为就诊表现。DKA组血脂、血糖及糖化血红蛋白均高于非DKA组,二分类logistic 回归分析示上述指标水平的升高均为酮症酸中毒的危险因素。IL-10水平在DKA组明显升高,余细胞因子在DKA组和非DKA组无明显差异。糖尿病组各细胞因子水平明显高于正常对照组。结论：1型糖尿病患儿酮症酸中毒发生率较高,糖、脂代谢紊乱是酮症酸中毒的危险因素。IL-10可能为酮症酸中毒的敏感指标。［中国当代儿科杂志,2010,12（11）：849-854］     

妊娠期糖尿病并酮症酸中毒七例报告

目的收集妊娠期糖尿病（GDM）发生酮症酸中毒（DKA）的病历,总结其经验教训。方法收集我院2006年10月至2008年10月期间所有诊治的妊娠期糖尿病酮症酸中毒病历,分析临床资料和母儿结局。结果2年间共收治妊娠期糖尿病酮症酸中毒病人7例,其发病率为0．4％,均未进行正规产检,无糖尿病家族史,占GDM的3．9％,足月活产1例,早产1例,围产儿死亡5例,1例孕产妇死亡。结论妊娠期糖尿病酮症酸中毒是一种急重并发症,严重影响母儿安全,应积极诊治和处理。     

Inborn errors of isoleucine degradation: a review

Three inborn errors have been identified in the pathway of isoleucine degradation. Deficiency of beta-ketothiolase (beta-KT, also known as T2, mitochondrial acetoacetyl-CoA thiolase and acetyl-CoA acetyltransferase 1) is a well-described disorder which presents with acute episodic ketoacidosis. In contrast, short/branched-chain acyl-CoA dehydrogenase (SBCAD) and 2-methyl-3-hydroxybutyryl-CoA dehydrogenase (MHBD) deficiencies are recently described and relatively rare defects which present with predominantly neurological manifestations, although acute metabolic decompensation may occur in the early newborn period. Careful examination of urine organic acids is required for identification and differential diagnosis of these disorders, with awareness that the abnormalities may be subtle and variable. Tandem MS analysis of acylcarnitines may reveal elevated C5 (SBCAD) or C5:1 and/or OH-C5 species (MHBD and beta-KT deficiencies) but the abnormalities are non-diagnostic and may be intermittent or absent. Confirmation of diagnosis is therefore advisable by specific enzyme assay and/or mutation analysis of the ACAT1 (beta-KT), ACADSB (SBCAD) or HADH2 (MHBD) genes. The latter is located on the X chromosome, accounting for the milder clinical phenotype in females. If beta-KT deficiency is diagnosed early and treated by fasting avoidance and modest protein restriction, ketoacidosis episodes can be prevented and the prognosis is excellent. The role of treatment in SBCAD deficiency remains unclear pending further delineation of its clinical phenotype and pathogenicity, particularly regarding asymptomatic individuals detected by expanded newborn screening. The ineffectiveness of isoleucine restriction in MHBD deficiency is consistent with the additional roles of this multifunctional enzyme in sex steroid and neurosteroid metabolism and its interaction with amyloid-beta peptide.     

急性酒精中毒的临床诊治体会

目的:对急性酒精中毒的临床分析。方法:对本院收集的513例酒精中毒患者的临床资料进行分析。结果:除1例过度饮酒导致猝死的患者,其余均在24 h内清醒,临床症状消失后出院,无明显脏器功能损害和严重并发症。结论:急性酒精中毒对意识和呼吸具有明显的抑制作用,对心脑血管具有低剂量兴奋,高剂量抑制的作用,对消化系统具有明显的应急损害,治疗中不仅要重视酒精中毒的本身损害,而且要注重并发症的治疗。     

COVID-19 vaccination and diabetic ketoacidosis

An efficient coronavirus disease 2019 (COVID-19) vaccine is urgently required to fight the pandemic due to its high transmission rate and quick dissemination. There have been numerous reports on the side effects of the COVID-19 immu-nization, with a focus on its negative effects. Clinical endocrinology is extremely interested in the endocrine issue that arises after receiving the COVID-19 vaccine. As was already mentioned, after receiving the COVID-19 vaccine, many clinical problems could occur. Additionally, there are some compelling reports on diabetes. After receiving the COVID-19 vaccine, a patient experienced hyperosmolar hyperglycemia state, a case of newly-onset type 2 diabetes. There has also been information on a potential connection between the COVID-19 vaccine and diabetic ketoacidosis. Common symptoms include thirst, polydipsia, polyuria, palpitations, a lack of appetite, and weariness. In extremely rare clinical circumstances, a COVID-19 vaccine recipient may develop diabetes complications such as hyperglycemia and ketoacidosis. In these circumstances, routine clinical care has a successful track record. It is advised to give vaccine recipients who are vulnerable to problems, such as those with type 1 diabetes as an underlying illness, extra attention.     

不同类型糖尿病患者血β-羟丁酸水平的差异

目的探讨各型糖尿病中实际存在的酮体代谢紊乱情况及其与空腹血糖(FPG)的关系,以期增强临床对早期酮体代谢紊乱的识别和防治能力。方法选择非糖尿病健康对照者(正常对照组)101名,男45名,女56名,平均年龄为(56±16)岁;1型糖尿病患者(T1DM组)42例,男20例,女22例,平均年龄为(41±18)岁;2型糖尿病患者(T2DM组)101例,男48例,女53例,平均年龄为(64±12)岁;线粒体糖尿病患者(MDM组)12例,男6例,女6例,平均年龄为(43±8)岁。测定4组的FPG和血β-羟丁酸(HBA)浓度,比较T1DM和T2DM组血HBA水平与FPG的相关性。结果3个糖尿病组的血HBA水平均显著高于正常对照组(P值均<0.01),其中T1DM组最高,明显高于T2DM组(P<0.01)。T2DM组的血HBA水平与FPG不相关(P=0.14),而T1DM组的血HBA水平与FPG呈正相关(r=0.68,P<0.01)。按FPG水平进一步将T1DM分成两个亚组:FPG≥11.1 mmol/L亚组的血HBA水平为(369.89±123.20)/μmol/L,较FPG<11.1 mmol/L亚组的(134.82±92.13)/μmol/L明显升高(P<0.01)。结论T1DM患者即使血糖轻、中度升高,也伴有轻度的酮体代谢异常,且随FPG的升高合并酮症或酮症酸中毒的可能性增大,应积极控制其血糖水平,防止发生高酮血症。