糖尿病双语教学课件.ppt

* 胰岛素治疗： （一）适应症 1. 1型糖尿病，需终生胰岛素替代 治疗。 2. 2型糖尿病，经口服降糖药治疗效果不好的。 3. 出现急慢性并发症时。 4. 应急：手术、外伤、妊娠、分娩时。 5. 2型糖尿病较重的，身体状况较廋、较差的。 * Hans Christian Hagedorn 1923 胰岛素第一次用于治疗糖尿病， 1938鱼精蛋白锌胰岛素(PZI)（诺和公司）， 1953lente长效胰岛素，由于动物胰岛素存在提纯不好，抗体反应等缺点， 1973单组分胰岛素被纯化，但是仍不能解决动物胰岛素存在的根本问题；到1987第一支人胰岛素问世，并于同年应用于人，因为与人的天然胰岛素氨基酸序列完全相同，所以抗原性大大降低。从动物胰岛素到人胰岛素是胰岛素历史的极大进步，但是由于外源性胰岛素与内源性胰岛素的吸收途径不同，在临床应用上仍然存在缺点：人胰岛素需要提前给药，其作用高峰延迟，不能完全模拟生理性胰岛素分泌，所以胰岛素类似物概念应运而生。 Hans Christian Hagedorn was apparently the first to use insulin in humans in (although Lilly would have it first used in 1922); however Lilly would also have their first commercially available insulin in 1923 so the data can stand. Lilly source: /Products/InsulinMilestones.cfm. Zinc protamine insulin was first marketed by Novo in. Lente insulin followed in, and monocomponent insulin in. Human insulin production was started by Novo in. Insulin analogues were first used in humans in that same year but were not marketed until 1996。 胰岛素的历史-- * Banting and Best和一条切除胰腺的狗。1880 Mehring and Minkowski 证实胰腺切除可以引起糖尿病，但是用粗提的胰腺提取物不能治愈糖尿病。Banting在十九世纪二十年代发明了一种通过结扎胰腺数周后让非胰岛组织萎缩退化的方法提取胰岛素，这种提取物的却在去胰腺狗中达到了降血糖的效果。这是世界上第一次从胰腺分离降血糖物质－胰岛素。 Banting and Best的提取方法是存在污染的，导致了注射部位的脓肿形成。JB Colip，生物化学家，跟他们一道纯化提取物从一开始的胎儿，到后来的小牛都被用作试验用。 Banting and Best, together with a (presumably depancreatized) dog. That diabetes could be induced by pancreatectomy had been shown by Mehring and Minkowski in the 1880s, but they failed to control the disease with a crude pancreatic extract. Banting developed a technique in the early 1920s of ligating the pancreas, allowing the non-islet tissue to degenerate over a period of weeks, and then making an islet preparation from the remainder. This preparation did reduce blood sugar in a second, depancreatized dog. This was the first isolation of an antidiabetic substance – insulin (although originally called isletin by Banting and Best) – from the pancreas. Banting and Best’s isletin preparation was nasty stuff, causing abscesses at t