[ppt模板]低血糖

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1、低血糖症蔡晓频1Whipple三联症1938年提出低的血糖数值低血糖症状自主神经兴奋（饥饿，心悸，出汗，恶心，震颤，焦虑）中枢神经系统功能受损（乏力，抽搐，昏迷）纠正血糖后症状缓解2010-5-212最常见原因糖尿病相关DCCT：1型糖尿病患者10~30%经历1次严重低血糖UKPDS：胰岛素治疗的2型糖尿病患者1.2%发生严重低血糖1型与2型相似2010-5-213糖稳态的调节胰岛素胰高糖素肾上腺素生长激素皮质醇调节受损（药物，糖尿病，肝衰竭，肾衰竭）2010-5-214低血糖分类空腹低血糖反应

2、性低血糖（餐后低血糖）2010-5-215空腹低血糖病因药源性高剂量水杨酸，β阻滞剂，磺胺药，奎宁，奎尼丁，喹诺酮类器官衰竭（肝，肾，内分泌病）肿瘤（非胰岛细胞肿瘤，胰岛细胞瘤，胰岛细胞增生）自身免疫（IAA,IRA）2010-5-216反应性低血糖倾倒综合症（核素胃排空试验）糖尿病前期胰岛细胞增生2010-5-217胰岛细胞瘤Approximately90%ofinsulinomasaresingleandbenign;10to15%,usuallymultipleadenomas,areas

3、sociatedwithmultipleendocrineneoplasia2010-5-218胰岛细胞瘤Whentheclinicalsuspicionispresent,diagnosisdependsonthedemonstrationofhyperinsulinemichypoglycemia.2010-5-219胰岛细胞瘤定性诊断Ifspontaneoushypoglycemiaisnotencountered,supervisedprolongedfastingmayberequir

4、ed.Inthepresenceofaninsulinoma,thesemiautonomousbasalinsulinsecretioninhibitshepaticglucoseefflux,leadingtofastinghypoglycemia.Thefindingofhypoglycemia(plasmaglucose<2.2mmol/Lor40mg/dL)associatedwithinappropriatelevelsofinsulin(>6μU/mL),C-peptide(>0.

5、2nmol/L),andproinsulin(>20pmol/L)isusuallyconsidereddiagnostic2010-5-2110胰岛细胞瘤定性诊断Prolongedfastingwithdemonstrationofhypoglycemiaalthoughrecognizedasthegoldstandardofdiagnosis,isuncomfortabletothepatientandispotentiallyhazardous.Ginetal.reportedonthe

6、useofeuglycemichyperinsulinemicclamptodiagnosinsulinoma.PatientswithinsulinomashowedlackofC-peptidesuppressionduringthreesuccessive90-minuteexogenousinsulininfusionsofupto8mU/kg/min,incontrasttocontrolsubjects,whoselevelsprogressivelyfellto0.3±0.1ng/

7、mLbythethirdphase.UsingC-peptidelevelatphase3of0.3ng/mLasthecut-offpoint,patientswithinsulinomaweredistinguishedfromcontrolsubjectswithasensitivityof100%.Thetestlastedonly270minutesandallpatientsremainedeuglycemicthroughoutthestudy.2010-5-2111胰岛细胞瘤定位

8、诊断Preoperativelocalizationoftumorsusingconventionalimagingmodalitiessuchasultrasonographyandcomputedtomographyhavebeendisappointing,withidentificationofonly20to50%oftumors2010-5-2112超声Transabdominalultrasonographyhasareportedsensitivitybetween7to79%，