软饮料导致的青少年糖尿病酮症的治疗及预后分析  

Therapy and prognosis of soft-drink diabetic ketosis in youth

作　　者：厉平[1] 高嵩[2] 李玲[1] 刘聪[1] 王艳军[1] 陈威[1] 吴波[1] 岳桂英[1] 

机构地区：[1]中国医科大学附属盛京医院内科,沈阳110004 [2]中国医科大学,沈阳110001

出　　处：《实用药物与临床》2007年第3期145-147,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的研究软饮料导致的青少年糖尿病酮症的临床特点和预后情况,探讨该症的发病机制和治疗对策。方法选择10例以大量摄入含糖软饮料为明确诱因的初发2型糖尿病酮症或酮症酸中毒青少年患者,胰岛素治疗好转后跟踪随访半年,分别在入院初、血糖理想控制一周以上和出院半年后测定血糖、血清胰岛素或C-肽,以判断胰岛β细胞分泌功能,行高胰岛素正血糖钳夹试验以定量测定胰岛素抵抗程度。结果10例病例的特点是都有家族史、明显肥胖、皮肤黑棘皮病样表现,血中胰岛自身抗体阴性。入院时血清胰岛素和C-肽水平明显降低;血糖理想控制1周后水平均明显升高(P均<0.05);钳夹试验中葡萄糖输注速率(GIR)显著低于正常人。随访半年时BMI均有不同程度下降(差异不显著),全部停止口服用药,维持血糖于正常糖耐量(5例)或异常糖耐量(5例)。而空腹胰岛素/C-肽和糖负荷后2h胰岛素/C-肽水平均进一步显著升高(均P<0.01),呈现高胰岛素血症和高C肽水平。行第二次钳夹试验的病例其GIR值均比第一次钳夹试验有明显提高(P<0.01),但仍低于正常人。结论软饮料导致的糖尿病酮症预后良好的原因是虽然有严重胰岛素抵抗,但胰岛功能尚有很强的代偿能力;而大量摄入含糖软饮料导致糖毒性,使β细胞分泌功能暂时下降及胰岛素抵抗加重,引起糖尿病发病;糖毒性纠正后,β细胞分泌功能如果能足以抵消胰岛素抵抗的代偿水平,可以不引发糖尿病。Objective To study the clinical characteristics and prognosis of soft-drink diabetic ketosis in youth, and to explore the mechanism and treatment of the disease. Methods A half-year follow-up for 10 young patients with first-episode type 2 diabetes presenting with DK or DKA with a history of excessive intake of sugar-containing soft drinks was performed. We determined the plasma glucose and insulin levels or the C-peptide levels to assess the island be- ta-cell function, and used hyperinsulin-euglycemic clamp to measure insulin resistance on admission and on days when their plasma glucose had been well controlled for at least a week and on the sixth month after discharge, respectively. Resuits Ten patients had some clinical characteristics in common with positive diabetic family history, obvious obesity, acanthosis nigricans-like sign and negative results for autoantibodies. On admission the levels of insulin and C-peptide were low, and were significantly increased when their values of blood glucose were well controlled for one week（ P 〈 0.05）. In the hyperinsulin-euglycemic clamp（ the clamp）, the glucose infusion rates（GIR）of the subjects were markedly lower than those of normal men. After the half-year follow-up, all the patients had a decreased body mass index（show no significant difference）and had stopped oral agents but glucose tolerance was normal （NGT, n = 5）or impaired slightly（ IGT, n = 5）. After half a year, the insulin or c-peptide levels of fasting and after OGTT were all remarkably increased and even much higher than the normal range. Compared with the GIR in hospitalization, the subjects who received the clamp the second time had much higher values（P 〈 0.01 ）, which were still lower than normal. Conclusion The fine prognosis of soft-drink diabetic ketosis was because the severe insulin resistance could be compensated by the strong insulin secretion function. The excessive intake of soft drinks led to glucose toxicity which damaged the island beta-cell function and ins

关 键 词：软饮料 糖尿病酮症 葡萄糖毒性 

分 类 号：R587.1[医药卫生—内分泌]