多次胰岛素皮下注射和胰岛素泵治疗糖尿病酮症酸中毒的疗效比较

目的：比较多次胰岛素皮下注射和胰岛素泵治疗糖尿病酮症酸中毒的临床疗效。方法：将我院2008年2月～2010年8月收治的糖尿病酮症酸中毒的患者84例随机分为皮下注射组和胰岛素泵组,每组42例,皮下注射组患者给予多次胰岛素皮下注射治疗,初始用量0.1 U/(kg·h),至血糖降至13.9mmol/L后改为5％葡萄糖水与胰岛...     

糖尿病住院患儿药物治疗情况分析

目的:了解我院普通糖尿病与糖尿病酮症患儿的治疗及费用情况,为优化患儿生活质量、减轻其家庭经济负担提供依据.方法:对184例糖尿病患儿住院治疗情况进行调查分析.结果:184例糖尿病患儿平均每次住院费用13 247.61元.112例有酮症的患儿平均住院费用15 418.71元;人均总药费4 739.395元,人均抗生素费用2 298.3元,占人均总药费的48.5％,平均住院天数21.0d.72例普通糖尿病患儿平均住院费用9 989.352元;人均总药费2434.626元,人均抗生素费用681.4元,占人均总药费的28.0％,平均住院天数16.8 d.全部患儿预后良好,但治疗中存在抗菌药物滥用问题.结论:糖尿病酮症患儿的住院天数、治疗费用、感染率均明显高于普通糖尿病患儿.糖尿病患儿易并发感染,治疗中应该合理使用抗生素.     

Gatifloxacin-induced severe hyperglycaemia and ketoacidosis in a non-diabetic renal transplant recipient

Gatifloxacin has been reported to cause dysglycaemia, especially in the elderly and in diabetics. In this communication, we describe a case of a non-diabetic renal transplant recipient who came to us in a state of diabetic ketoacidosis following the use of gatifloxacin for a urinary tract infection.     

Modestly increased beta cell apoptosis but no increased beta cell replication in recent-onset type 1 diabetic patients who died of diabetic ketoacidosis

Aims/hypothesis Type 1 diabetes is characterised by a deficit in beta cell mass thought to be due to immune-mediated increased beta cell apoptosis. Beta cell turnover has not been examined in the context of new-onset type 1 diabetes with diabetic ketoacidosis. Methods Samples of pancreas were obtained at autopsy from nine patients, aged 12 to 38 years (mean 24.3±3.4 years), who had had type 1 diabetes for less than 3 years before death due to diabetic ketoacidosis. Samples of pancreas obtained at autopsy from nine non-diabetic cases aged 11.5 to 38 years (mean 24.2±3.4 years) were used as control. Fractional beta cell area (insulin staining), beta cell replication (insulin and Ki67 staining) and beta cell apoptosis (insulin and TUNEL staining) were measured. Results In pancreas obtained at autopsy from recent-onset type 1 diabetes patients who had died of diabetic ketoacidosis, the beta cell deficit varied from 70 to 99% (mean 90%). The pattern of beta cell loss was lobular, with almost all beta cells absent in most pancreatic lobules; islets in lobules not devoid of beta cells had reduced or a near-normal complement of beta cells. Beta cell apoptosis was increased in recent-onset type 1 diabetes, but to a surprisingly modest degree given the marked hyperglycaemia (30 mmol/l), acidosis and presumably high NEFA. Beta cell replication, scattered pancreatic beta cells and beta cells in exocrine ducts were not increased in recent-onset type 1 diabetes. Conclusions/interpretation These findings do not support the notion of active beta cell regeneration by replication in new-onset type 1 diabetes under conditions of diabetic ketoacidosis. The gluco-lipotoxicity reported in isolated human islets may be less evident in vivo.     

儿童糖尿病酮症酸中毒20年回顾分析

目的 探讨降低儿童糖尿病酮症酸中毒（DKA）的发病率、提高儿科治疗DKA的成功率的方法。方法 回顾分析了20年胰岛素依赖型糖尿病住院儿童114例（其中DKA53例）的资料。,结果 1999-2004年和1985-1991年或1992-1998年比较,DKA发病率明显下降（P〈0．05）,年龄越小,DKA发病率越高,父母文化程度低的农村儿童发病率明显高于城镇儿童。DKA的诱因中,感染列首位（49．1％）,停用胰岛素其次（20．8％）,减少使用碳酸氢盐量的一组,其代谢恢复及住院时间均较剂量较大的两组明显缩短（P〈0.05）。结论 加强小儿糖尿病管理力度非常重要。较大剂量碳酸氢盐对治疗DKA有潜在的不利影响。     

白细胞介素-18和白细胞介素-12在儿童1型糖尿病酮症酸中毒中的作用

目的探讨白细胞介素-18(IL-18)、白细胞介素-12(IL-12)和干扰素-γ(INF-γ)在儿童1型糖尿病酮症酸中毒(DKA)中的作用。方法采用酶联免疫吸附(ELISA)方法检测61例儿童1型糖尿病(T1DM)患儿(其中28例伴DKA,33例无DKA)和30例正常对照者IL-18、IFN-γ和IL-12的血清水平。结果(1)T1DM患儿中血清IL-18水平明显比对照组高[(691．99±381．42) pg/ml vs(310．02±265．32)pg/ml,P=0．03],而两组间IFN-γ和IL-12水平则无差别。(2)DKA组患儿中IL-18和IFN-γ血清水平明显高于无DKA组[(759．25±353．82)pg/ml vs(634．93±399．79)pg/ ml,P=0．001和(9．35±8．06)pg/ml vs(5．21±6．47)pg/ml,P=0．044],而两组间IL-12血清水平则无差别。(3)IL-18和IFN-γ呈相关趋势,而与IL-12正相关。结论DKA患儿IL-18和IFN-γ血清水平明显升高,提示其可能在DKA的发生、发展中起重要作用。     

以酮症起病的成年糖尿病患者自身免疫指标与尿微量白蛋白关系的探讨

目的：研究以酮症起病的成年糖尿病患者自身抗体和免疫球蛋白水平与尿微量白蛋白的关系。方法：回顾性分析42例首诊表现有酮症的成年糖尿患者（K组）和30例新发无酮症倾向的2型糖尿病患者（c组）尿微量白蛋白、谷氨酸脱羧酶抗体（GADAb）、胰岛细胞抗体（ICA）、免疫球蛋白（IgA、IgG、IgM）等指标。以GADAb和／或ICA阳性与否再分为胰岛自身抗体阳性组（A组）和抗体阴性组（B组）,对比上述指标。结果：K组尿微量白蛋白阳性率（24h尿微量白蛋白〉30mg为阳性）、GADAb和／或ICA阳性率和IgG水平高于C组;A组尿微量白蛋白阳性率、IgG水平高于B组。结论：以酮症起病的成年糖尿病患者尿微量白蛋白升高与自身免疫异常相关（R=0．621）。     

Endothelin excretion during ketoacidosis does not correlate with tubular dysfunction

Urinary excretion of endothelin was measured by radioimmunoassay in children with diabetes mellitus during severe ketoacidosis and 12 days later when blood pH and blood glucose concentrations were normal. Metabolically stable diabetic children served as controls. Results from apparently healthy children without diabetes mellitus were used as normal values. Renal tubular injury was evaluated by the urinary excretion of the proximal tubular marker ₁-microglobulin and the distal tubular marker Tamm-Horsfall protein (THP). During ketoacidosis we detected a decreased glomerular filtration rate associated with highly significant changes in the excretion of ₁-microglobulin, indicating proximal tubular damage, and THP, suggesting disturbance of cells of the ascending loop of Henle. The daily excretion of endothelin was unaltered but the ratio of endothelin/creatinine or endothelin excretion/creatinine clearance were significantly enhanced. In conclusion, we could demonstrate that, despite a proximal and distal tubular cell dysfunction, endothelin excretion when related to creatinine clearance may be a consequence of disturbed proximal tubular function or dysfunction of the renal medulla.     

Measuring outcome of diabetes: a retrospective survey

The feasibility of using hospital discharge data to monitor six outcome indicators for diabetes care was assessed by reviewing retrospectively the occurrence of these events recorded in hospital records. The population studied was that of the Orkney Islands (19,500) over a 10-year period (1976-1985). During that time, 230 Orkney diabetic patients were treated in Orkney and/or Aberdeen hospitals. The six outcome indicators were: hospital admission rates for diabetic patients (609 in 230 patients), hospital admission rates specifically for diabetic ketoacidosis (29 in 20 patients), rates of diabetes-related lower limb amputations (36 in 23 patients), perinatal mortality rates related to maternal diabetes (nil), visual loss or blindness (13 eyes in 9 patients) and end-stage renal failure (one patient). Scottish Morbidity Returns (which collect data similar to that in the Hospital In-patient Enquiry in England) were shown by case note review to underestimate these outcomes by 41%. Cardiovascular disease, cerebrovascular disease, and peripheral vascular disease accounted for half of all in-patient bed use by diabetic patients (6077 of 13,951 days). The routinely available Scottish hospital discharge data, which are collected for a different purpose, are not sufficiently accurate or complete to reflect variations in actual diabetic events.     

The catabolic triad: case report of fasting,major cardiac surgery and sodium–glucose co-transporter 2 inhibitors leading to perioperative euglycaemic ketoacidosis

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are novel oral hypoglycaemic agents. For patients with diabetes mellitus, without a prior history of myocardial infarction or atherosclerotic disease, SGLT2i have been shown to reduce incident heart failure and worsening renal function. SGLT2i therapy is increasing among patients presenting for cardiac surgery. However, the perioperative use of SGLT2i carries a significant risk of euglycaemic diabetic ketoacidosis, due to their catabolic mechanism of action. This case report demonstrates euglycaemic ketoacidosis post-coronary artery bypass grafting secondary to SGLT2i, highlighting the multiple risk factors and consequences of this iatrogenic complication.