特发性餐后低血糖症滋养性低血糖浙江大学.pptxVIP

浙江大学医学院附属第二医院 王永健;定义;;;病因;分类;低血糖的分类--空腹低血糖症; 低血糖的分类--餐后低血糖症 （反应性低血糖症）;病理生理;严重神经低血糖症 意识水平降低 惊厥 昏迷;机体对低血糖防御机制;临床表现;;低血糖导致神经缺糖性损害;低血糖影响大脑功能;大脑中血糖水平远远低于循环中血糖水平;低血糖影响大脑功能;轻-中度低血糖降低大脑视觉和听觉皮层局部活性;低血糖影响认知功能;低血糖影响驾驶能力;临床表现严重程度;诊断;诊断;高胰岛素血症性低血糖症的鉴别;Hypoglycemia Pathway;治疗;低血糖的处理：神志清楚者;低血糖的处理：神志不清楚者; 胰岛B细胞瘤(胰岛素瘤);临床表现 ;临床表现 ; 定性诊断（1）; 定性诊断（2）;定位诊断;治 疗;（1）胰岛素自身抗体： 抗体结合大量胰岛素，突然解离，血糖急剧下降。 胰岛素治疗产生胰岛素自身抗体的患者可以出现空腹 或延迟性餐后低血糖以及相对性高胰岛素血症。 还可见于SLE以及抗甲亢药物治疗时如他巴唑、甲亢平 （2）胰岛素受体的自身抗体：少见 封闭胰岛素与受体的结合，致胰岛素抵抗， 偶与胰岛素受体结合产生类胰岛素样作用， 见于黑棘皮病。 ;Autoimmune causes Anti-insulin receptor antibody Rarely, hypoglycemia is caused by autoantibodies that bind the insulin receptor and mimic the biologic action of insulin Most patients have elevated ESR, +ve ANA Anti-insulin antibody autoantibodies against insulin bind free circulating plasma insulin when its concentration is high and release insulin when the concentration of free plasma insulin drops. Release of insulin at inappropriate times can cause hypoglycemia. ;Reactive hypoglycemia is controversial low postprandial plasma glucose levels alone are not sufficient 10% to 30% of normal individuals undergoing oral GTT have plasma glucose 50 mg/Dl, with no symptoms Only patients with severe (eg, loss of consciousness, traumatic injury or accident) attributed to postprandial hypoglycemia require further workup. ;Dumping Syndrome/ Alimentary Hypoglycemia;Questions;Questions;Questions;Questions;Questions;Questions;Questions;Questions;Questions;Questions;Questions