第二节儿童糖尿病.docVIP

第二节 儿童糖尿病 ? 　　一、概述　　Diabetes mellitus (DM) is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. When DM strikes during childhood, it is routinely assumed to be type 1, or insulin-dependent diabetes mellitus (IDDM). Most children with diabetes have IDDM and a lifetime dependence on exogenous insulin. However, in the last 2 decades, type 2 diabetes (non–insulin-dependent diabetes mellitus, NIDDM) already appears to be a sizable and growing problem among children. It is hard to detect NIDDM in children because 1) it can go undiagnosed for a long time; 2) children may have no symptoms or mild symptoms; and 3) blood tests are needed for diagnosis. DM has a tendency to progression of an array of complications such as microvascular disease, macrovascular disease and nonalcoholic fatty liver disease. Therefore, better physician awareness and monitoring of the disease’s magnitude will be necessary.　　 （一）定义　　儿童时期的糖尿病是指在15岁以前发生的糖尿病。以前曾称为儿童糖尿病，但由于儿童时期的糖尿病的病因、临床表现、治疗和预防的不同，儿童糖尿病的名称早已舍弃不用。通常分为三类：　　1. 1型糖尿病（type1 diabetes mellitus） 主要是在遗传因素作用下，由于环境因素激发的体内自身免疫反应，使胰岛β细胞损伤并遭到破坏，导致胰岛素绝对不足，是胰岛素依赖型糖尿病（insulin-dependentes mellitus, IDDM）。　　2. 2型糖尿病（type2 diabetes mellitus） 是一类胰岛β细胞分泌胰岛素相对不足或/和靶细胞对胰岛素不敏感，即胰岛素拮抗所致的糖尿病，是非胰岛素依赖型糖尿病。　　3. 其他类型 β细胞功能的遗传缺陷、胰岛素作用的遗传缺陷、内分泌疾病引起的糖尿病、药物或化学物诱导的糖尿病、感染等。　　 （二）流行病学　　儿童时期的糖尿病绝大多数是1型糖尿病中的免疫介导型，但今年儿童的2型糖尿病有逐年增加的趋势。我国内地22个地区平均发病率为0.56/105，约占糖尿病总发病例数的5%。儿童时期的糖尿病好发年龄多见于10～14岁，婴幼儿少见。秋、冬季节高发。　　 （三）临床表现　　1型糖尿病儿童起病较急，多数病人常因感染、饮食不当或情绪激惹的诱发起病。表现为多尿、多饮、易饿多食和体重减轻，俗称“三多一少”。但多数儿童多饮多尿不易被发现而很快发展为脱水及酮症酸中毒。　　糖尿病儿童可以突发恶心、呕吐、厌食或腹痛、腿疼等症状，应考虑酮症酸中毒的可能，应尽早诊断。　　体格检查糖尿病时除消瘦外一般无阳性体征。学龄儿童科发生夜间遗尿，部分儿童食欲正常或减低，体重减轻很快消瘦、乏力及精神萎靡。 　二、营养代谢特点　　DM is caused by the deficiency of insulin, which is produced by the β cells of the islets of Langerhans located in the pancreas, and the absence, destruction, or other loss of these cells results in IDDM. Whereas NIDDM is a heterogeneous disorder independently associated wit