蛋白质能量营养不良综述.pptVIP

* * * * * * * * * * * * * * * * 蛋白质——能量营养不良（Protein-Energy Malnutrition, PEM） Ass Prof. Wang Bin Dept of Pediatrics Zhujiang Hospital, SMU e-mail: wangbin6556@126.com 基本内容 基本概念 病因 病理生理 病理 临床表现 及分类：分类、度、型 诊断 治疗 basic concept of PEM In abbreviation: malnutrition Chronic deficiency disease caused by shortage of energy and/or protein supply. Usually 3y，character: BW →OR↓、wasting or edema、subcutaneous fat ↓OR disappear，accompany with various degrees of organ failure and metabolic disorders. Terms and definition 低体重（under-weight）：mean BW -2SD of the same age, same sex ; OR BW in the 3d percentile 消瘦（wasting）：STATURAL BW -2SD of the same age, same sex ; OR STATURAL BW in the 3d percentile 生长迟缓（stunting)：mean BL -2SD of the same age, same sex ; OR BL in the 3d percentile 病因 improper feeding：breast milk insufficient、dietary bias、quantity not sufficient diseases ：diarrhea、intestinal absorption disorder 、infection、tumor、nephrotic syndrome Congenital ：multiplets、premature birth、maternal malnutriton，malformation of GI、harelip唇裂、cleft palat腭裂 pathophysiology（一）metabolism disorders protein metabolism disorders ：ALB ↓ ，globulin ↓ 、low protein edema. Glycometabolism disorders ：hypoglycemia/asymptomic，，glucogen↓，glucose tolerance↓ fat metabolism disorders ：chol↓，甘油三酯积累→adiposis hepatica water-electrolyte metabolism disorders ：body fluid↑，hypotonic，Na+↓，K+↓、Ca↓，acidosis、Mg↓、2n↓、Fe↓ Thermoregulation disorders：hypothermia a. heat production↓ b. heat radiation↑ pathophysiology（二）organ failure digestive function↓：digestive enzyme↓、movement↓、dysbacteria菌群失调→digest↓tolerance↓→diarrhea circulation system↓：myocardial contractility↓→cardiac output↓、BP↓、 glomerulus及renal tubule功能↓：creatinine↑、diuresis多尿、低比重hypobaric尿 central nervous system inhibition immunity↓：非特异免疫↓— 皮肤屏障↓、WBC功能↓、补体↓、Ig↓、IgG2及IgG4缺陷、淋巴细胞↓、NK↓、APCC↓ 特异免疫↓— 免疫反应↓ Pathology mild：only subcutaneous fat↓、slightly atrophia of muscle severe：organs diminution，but liver, spleen, heart ,