儿童1型糖尿病的流行病学及治疗进展-儿科专业论文.docxVIP

目 录 中文摘 要·························································································································· ······················1 英文摘 要·························································································································· ······················3 英文缩 写·························································································································· ······················5 综述 儿童 1 型糖尿病的流行病学及治疗进 展······························································6 参考文 致  献········································································································ ·····································19 谢·························································································································· ······························24 个 人 简 历·························································································································· · · · · · · · · · · · · · · · · · · · 2 5 儿童 1 型糖尿病的流行病学及治疗进展 摘 要 1 型糖尿病作为儿童最常见的内分泌系统慢性疾病，是胰岛β细胞破 坏和功能衰竭而引起的机体分泌胰岛素不足的自身免疫性疾病，其发病率 呈逐年上升的趋势。不同地区对于儿童和青少年 1 型糖尿病的发病率与性 别、年龄、出生月份、城乡地区分布等特点的调查结果不一。大部分研究 显示，儿童 T1DM 发病季节多为较冷的季节，而夏季较少，而其发病高 峰年龄在 10-14 岁，但是，低年龄组发病率上升速度最快。 1 型糖尿病发病机制复杂，是基因和环境因素综合作用的结果。1 型 糖尿病的遗传易感性主要与位于 6 号染色体上的组织相容性抗原（HLA） 相关。但并不是所有具有高遗传易感性的人都会发展为 T1DM，环境因素 也起着很重要的作用，其中包括病毒感染、维生素 D 的摄入水平、喂养 方式以及其他如母亲怀孕年龄、孕期毒物接触史、孕期的职业暴露等。 1型糖尿病的治疗总是面临着降低高血糖和避免低血糖的挑战。胰岛 素的治疗始于1923年，在胰岛素被发现之前，人们已经意识到绝大多数的 患病儿童在糖尿病发病的1年之内即死去。除了传统的“五架马车”，人们 中 文 摘 要 一直在坚持不懈的探索T1DM新型治疗方法。人们通过改变胰岛素分子结 构以使其具有更稳定的半衰期及更小的不良反应。胰岛素的给药方式也经 历着从传统的皮下注射到持续输注乃至尝试吸入剂型的进步。持续血糖监 测系统越来越精准，并且逐渐在临床上推广应用。智能手机尝试通过整合 血糖水平和食物摄入来精确计算所需的胰岛素用量，使其成为辅助治疗糖 尿病的新方式。闭环系统能通过实时监测血糖水平来自动计算调整胰岛素 用量。尽管尚未完全成功应用于临床，但是通过胰岛、胰脏-肾脏和干细 胞移植治疗1型糖尿病的尝试一直没有间断。胰岛素基因治疗是治疗1型糖 尿病的另一个新型疗法，但是目前仍然处于探索理想的载体和靶细胞的阶 段。最重要的是，预防比治疗更重要，目前有学者正在通过免疫学方法研 究可以预防糖尿病的疫苗。 本文主要从 1 型糖尿病的发病率、发病机制及治疗进展三个方面进行 综述。 关键词：1 型糖尿病的发病率, 1 型糖尿病的发病机制, 1 型糖尿病的 治疗进展, 胰岛素, 动态血糖监测, 闭环系统, 胰岛素基因治疗 The Epidemio