酮症酸中毒与月经PPT课件.pptVIP

患者2012.9、2012.10、2012.11连续3次因糖尿病酮症酸中毒发病住院，现对其近3月来住院情况进行回顾。 * 2012.9.3~2012.9.21 入院前一周频繁出现低血糖症状自行停用胰岛素，急诊以“糖尿病酮症酸中毒”收入院。 2012.10.10~2012.10.23 出院后未检测血糖，入院前3天曾无明显诱因出现腹泻症状，不伴发热、腹痛，对症治疗后缓解。入院当日，患者晨起后自觉恶心不适，后呕吐3次，呕吐物为胃内容物，无呕吐咖啡色液体，无腹痛、腹泻。 * 血常规 3/9 9/11 10/11 单位 参考区间 WBC 9.51 6.28 8.72 10^9/L 4-10 RBC 3.67 4.06 4.28 10^12/L 3.5-5 HGB 106 120 129 g/L 110-150 PLT 297 304 299 10^9/L 101-320 HCT 32.50 34.80 36.60 % 37-43 NEUT 79.80 31.10 72.80 % 50-70 LYMP 16.70 5.40 21.30 % 20-40 * 血生化 3/9 17/9 10/10 15/10 单位 ALT 21.20 35.20 15.90 44.00 U/l AST 28.20 36.00 21.00 65.40 U/l UREA 4.2 3.9 3.0 3.2 mmol/l BUN 11.76 10.92 8.40 8.96 mg/dl CREA 49.00 58.90 42.10 59.30 umol/l * * 月经周期的激素变化：月经周期的开始阶段，雌激素和黄体酮都处于最低水平，月经第7日雌激素水平明显增加，于排卵前形成高峰，排卵后稍减少，约在排卵后1～2日，黄体开始分泌大量黄体酮与雌激素，使子宫内膜增厚，为孕育胚胎做好准备，如果没有受孕，体内雌激素和黄体酮水平迅速下降，子宫内膜开始脱落，形成月经。 * 研究显示，月经期胰岛素敏感性会下降，胰岛素敏感性的降低与月经周期里激素水平的变化．炎症及经前综合征有关。雌激素和黄体酮都能影响女性血糖水平，雌激素能增强胰岛素的敏感性。在月经期，体内雌激素和黄体酮水平下降，雌激素水平的降低使得胰岛素敏感性下降．而子宫内膜剥脱出血过程中，会对胰岛素产生拮抗作用，使血糖升高。 * 雌激素通过雌激素受体α防止胰岛β细胞的凋亡； 雌激素通过基因组效应机制保护β细胞； 雌激素和雌激素类似物能通过作用于β细胞的雌激素膜受体，产生一种快速的促胰岛素分泌功能； 雌激素对β细胞分泌有间接作用； * The clinic and hospital medical records of 2 subjects with type 1 diabetes mellitus (T1DM) and unexplained DKA are reviewed. An electronic MEDLINE search of relevant medical literature published from 1965 to 2007 was performed. Catamenial diabetic ketoacidosis and catamenial hyperglycemia:case report and review of the literature * To date there have been 7 reported cases between menstruation and DKA. The 2 new cases highlight the potentially significant changes in glucose metabolism during the late luteal and decidual phases of the menstrual cycle. * Through unclear mechanisms, some women with diabetes mellitus demonstrate significant changes in glucose control around the time of their menses, including DKA. Accordingly, we propose that the terms catamenial DKA and catamenial hyperglycemia be used to refer to these disorders and that catamenial DKA be included in the differential di