[PPT模板]低血糖.ppt

低血糖症 蔡晓频 Whipple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 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 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） 低血糖分类 空腹低血糖 反应性低血糖（餐后低血糖） 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） 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 胰岛细胞瘤 Approximately 90% of insulinomas are single and benign; 10 to 15%, usually multiple adenomas, are associated with multiple endocrine neoplasia 胰岛细胞瘤 When the clinical suspicion is present, diagnosis depends on the demonstration of hyperinsulinemic hypoglycemia. 胰岛细胞瘤定性诊断 If spontaneous hypoglycemia is not encountered, supervised prolonged fasting may be required . In the presence of an insulinoma, the semiautonomous basal insulin secretion inhibits hepatic glucose efflux, leading to fasting hypoglycemia. The finding of hypoglycemia (plasma glucose 2.2 mmol/L or 40 mg/dL) associated with inappropriate levels of insulin (6 μU/mL), C-peptide (0.2 nmol/L), and proinsulin (20 pmol/L) is usually considered diagnostic 胰岛细胞瘤定性诊断 Prolonged fasting with demonstration of hypoglycemia although recognized as the gold standard of diagnosis, is uncomfortable to the patient and is potentially hazardous. Gin et al. reported on the use of euglycemic hyperinsulinemic clamp to diagnos insulinoma. Patients with insulinoma showed lack of C-peptide suppression during three successive 90-minute exogenous insulin infusions of up to 8 mU/kg/min, in contrast to control subjects, whose levels progressively fell to 0.3±0.1 ng/mL by the third phase. Using C-peptide level at phase 3 of 0.3 ng/mL as the cut-off point, patients with insulinoma were distinguished from control subjects with a sensitivity of 100%. The test lasted only 270 minutes and all patients remained euglycemic throughout the study. 胰岛细胞瘤定位诊断 Preoperative localization of tumors using conventio