爷爷 爸爸 儿子 70岁得 50岁得 30岁得 糖尿病 糖尿病 糖尿病 "We have to treat early and carefully" ---W Duckworth
省医院 “We have to treat early and carefully” ---W Duckworth
多重病理机制导致高血糖 省医院 2 肠促，素反应减低 胰岛素分泌受损 脂解作用增强 胰岛细胞 葡萄糖重吸收增加 胰岛α细胞 高血糖 胰高血糖素分泌 增多 肝糖生成增多 葡萄糖植取减少 神经递质功能璋碍 改编自DeFronzo RA.Diabetes200958.773-795.©Wolters Kluwer Health
省医院 多重病理机制导致高血糖 改编自DeFronzo RA. Diabetes 2009;58:773–795. Wolters Kluwer Health 胰岛α细胞 脂解作用增强 葡萄糖重吸收增加 胰高血糖素分泌 增多 肝糖生成增多 神经递质功能障碍 葡萄糖摄取减少 胰岛β细胞 肠促胰素反应减低 高血糖 胰岛素分泌受损 2
1型、2型糖尿病临床分期 省医院 1型糖尿病 2型糖尿病 第1期 遗传易感性 遗传易感性及环境因素 第2期 启动自身免疫反 胰岛β细胞功能缺陷和 应。 胰岛素抵抗 第3期 免疫学异常 糖耐量减低 (IGT 第4期 进行性胰岛细 临床糖尿病 胞功能丧失 第5期 临床糖尿病 第6期 β细胞完全破坏
１型、２型糖尿病临床分期 省医院 １型糖尿病 ２型糖尿病 第１期 遗传易感性 遗传易感性及环境因素 第２期 启动自身免疫反 应。 胰岛β细胞功能缺陷和 胰岛素抵抗 第３期 免疫学异常 糖耐量减低（IGT） 第４期 进行性胰岛β细 胞功能丧失 临床糖尿病 第５期 临床糖尿病 第６期 β细胞完全破坏
型和Ⅱ型糖尿病的鉴别 省医院 1型糖尿 2型糖尿病 起病年龄及其峰值 多<25岁，12~14岁 多>40岁，60~65岁 起病方式 多急剧，少数缓起 缓慢而隐袭 起病时体重 多正常或消瘦 多超重或肥胖 “三多一少”症状 常典型 不典型，或无症状 急性并发症 酮症趋向大，易发生酮症酸中 酮症趋向小，50岁以上易发生 毒 非酮症高渗性昏迷 慢性并发症 肾病 35%~40%,主要死因 5%~10% 心血管病 较少 >70%,主要死因 脑血管病 较少 较多 胰岛素及C肽释放试验 低下或缺乏 峰值延迟或不足 自身免疫因素 ICA80%阳性IAA40~50 阴性 %阳性GADA6096%阳性 胰岛素治疗及反应 依赖外源性胰岛素生存，对胰 生存可不依赖外源性胰岛素， 岛素敏感 应用时对胰岛素抵抗
Ⅰ型和Ⅱ型糖尿病的鉴别 省医院 1型糖尿 2型糖尿病 起病年龄及其峰值 多<25岁，12～14岁 多>40岁，60～65岁 起病方式 多急剧，少数缓起 缓慢而隐袭 起病时体重 多正常或消瘦 多超重或肥胖 “三多一少”症状 常典型 不典型，或无症状 急性并发症 酮症趋向大，易发生酮症酸中 毒 酮症趋向小，50岁以上易发生 非酮症高渗性昏迷 慢性并发症 肾病 35％～40％，主要死因 5％～10％ 心血管病 较少 >70％，主要死因 脑血管病 较少 较多 胰岛素及C肽释放试验 低下或缺乏 峰值延迟或不足 自身免疫因素 ＩＣＡ80％阳性ＩＡＡ40～50 ％阳性ＧＡＤＡ60~96％阳性 阴性 胰岛素治疗及反应 依赖外源性胰岛素生存，对胰 岛素敏感 生存可不依赖外源性胰岛素， 应用时对胰岛素抵抗
省医院 There are 13 types of cancer associated with overweight and obesity,and these cancers accounted for approximately 40%of all cancers diagnosed in the United States in 2014,CDC reports. According to the latest Vital Signs report,about 630,000 people in the United States were diagnosed with a cancer tied to overweight and obesity in 2014.About two-thirds of the cases occurred in individuals aged 50-74 years.While the rates of non- obesity related cancers declined between 2005 and 2014,the rates of cancers associated with obesity-not including colorectal cancer rose by 7%during that period."A majority of American adults weigh more than recommended-and being overweight or obese puts people at higher risk for a number of cancers-so these findings are a cause for concern,"said CDC Director Brenda Fitzgerald,MD."By getting to and keeping a healthy weight,.-----CDC News Release (10/03/17)
省医院 There are 13 types of cancer associated with overweight and obesity, and these cancers accounted for approximately 40% of all cancers diagnosed in the United States in 2014, CDC reports. According to the latest Vital Signs report, about 630,000 people in the United States were diagnosed with a cancer tied to overweight and obesity in 2014. About two-thirds of the cases occurred in individuals aged 50–74 years. While the rates of nonobesity related cancers declined between 2005 and 2014, the rates of cancers associated with obesity—not including colorectal cancer—rose by 7% during that period. "A majority of American adults weigh more than recommended—and being overweight or obese puts people at higher risk for a number of cancers—so these findings are a cause for concern," said CDC Director Brenda Fitzgerald, MD. "By getting to and keeping a healthy weight, we all can play a role in cancer prevention.“------CDC News Release (10/03/17)