最新糖耐量异常【精品-】课件ppt.ppt

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1、糖耐量异常【精品-】strokeEKGabnormality18%hypertension35%anginacruris间歇性跛行7%4.5%retinopathy21%Diabeticnephropathy18.1%Erectiondisturbance20%notouchingarteriopalmusinfoot13%Skinischemicchangeinfoot6%Oscilloreceptionalthresholdinfoot足部振动感受阈异常7%IncidenceDomestic:1980→1994→20011.00%→2.51%→10.49%Abroad:USA,Euro

2、peWHO137million(1997)300million(2025)ThePatientsWithType2DMIncreaseRapidlyInChinaChinahasthesecondlargestnumberofDM19952025EtiologyCombinedFactorsHeredity,AutoimmunityandEnvironmentDefectsinplasmaglucosecontrol+GlucoseInsulinSecretionTissueEffects+-Impairedbeta-cellfunctionInsulinresistanceDiabet

3、esresultsfromtheinabilityofinsulinsecretiontomatchthebody’srequirementsClassification&featureofDM1999WHOStandard：type1DM、type2DM、otherspecialtypeDMandgestationalDMDifferencefromprecedingclassification：AccordingtopathogenesisIDDM≈T1DMNIDDM≈T2DMType1DMImmunity-mediatedtype1DM1.RelatedtoHLA－DQA、DQB、D

4、R2.AutoimmuneAntibody：GAD65、IA-2、IA-2β、ICAs、IAA3.AccompaniedwithotherautoimmunediseasesuchasGD,HT,andsoonIdiopathictype1DMLADA（LatentAutoimmunicDiabetesinAdults，成人迟发型自身免疫糖尿病）Onsetinadults,mostly22-48;obvioussymptomBMI≤25，FBG≥16.5mmol/LC-P≤0.4nmol/L,2h≤0.8nmolLHeritage(HLA-DQB57isnon-asparticacidi

5、sozygote，非门冬氨酸纯合子）SusceptibletootherautoimmunediseasesLADAPositiveautoimmuneAntibody：ICA，GADA，IA-2，IA-2βNoketosisin½year,mayappearslaterOHAeffectintheearlystage，butbecomeinvalidgradually,needtreatmentwithInsType2DMOccurpredominantlyasinsulinresistance(IR)ordeficiencyofinsulinsecretionHeterogenicit

6、y（异质性），differentclinicalmanifestationOccurpredominantlyinadult,esp.thataftermiddleagePredisposedtochroniccomplicationsNonspontaneousDKAOtherSpecificTypeofDMHereditoryfunctionaldefectofBcellsMODY(MaturityOnsetDiabetesMellitusinYoung)1.threeormoregenerationfamilyhistory2.<25yearsold3.noketonetendenc

7、y4.don’tneedinsulintherapyin5yearsOtherSpecificTypeofDMMutationofmitochondrialDNA1.maternalinheritance2.earlyonset3.disfunctionofBcell4.nervedeafnessHereditorydefectsofinsulinfunctionExocrinepancreasdiseasepancre