<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">由一例「低血糖」所引起的案例</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-06-23</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">张晓莉 梁书卉 刘曼</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:检验医学</em></h2></div><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">前言</span><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">1例2型糖尿病患者因出现恶心、四肢无力等症状就诊,自以为是低血糖的症状。通过临床医生与检验科及时检测与沟通,及时为患者提出新的降糖方案,使患者血糖恢复平稳状态,大大延缓了其糖尿病的病程。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">案例经过</span></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">患者刘某,女,63岁,身高163cm,体重70kg,BMI为26,已诊断2型糖尿病有10年。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">3月18日来医院常规糖尿病门诊就诊检查,HbA<sub>1c</sub>为10.0%,FPG为7.94mmol/L,2hPG为12.35mmol/L,TG 2.28mmol/L,TCHO 4.81mmol/L,HDL-C 1.59mmol/L,LDL-C 2.74mmol/L,UREA 3.4mmol/L,CRE 42.2 μmol/L,β2-MG 1.53mg/L;由于糖化血红蛋白数值较高,医生建议进一步检查其胰岛功能,但患者未引起注意,未进行检查。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">4月17日患者前来就诊,自述四肢无力、恶心、出虚汗等症状,自己以为是出现了低血糖,并连续几天参加聚餐摄入较多含糖量高的食物,未加控制。FPG为14.80mmol/L,尿常规:酮体(±),葡萄糖(3+);诊断为糖尿病酮症。医生进行纠酮治疗,注射盐水胰岛素,并停用降糖药盐酸二甲双胍片。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">4月18日血糖为12.47mmol/L;4月19日血糖为18.77mmol/L,尿常规:酮体为阴性,尿葡萄糖(1+),患者精神状态显著改善,呼吸保持平稳,典型症状改善;随后医生建议加强控制饮食,并检测胰岛功能。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">4月20日进行OGTT联合胰岛素、C肽释放试验,并选用2两馒头作为标准餐试验评估T2DM的胰岛功能,这样更近似于日常生活饮食,方便易操作<sup>[1]</sup>。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">结果表明此患者是处于相对胰岛素抵抗,又相对分泌不足的状态。建议更改降糖方案。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; white-space: normal; text-align: center; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><img src="https://studioyszimg.yxj.org.cn/2022013015220500127.png" title="" alt=""/></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></p><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; white-space: normal; text-align: center; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C017CDB483D02BD3F7FC8495D.jpg" style="margin: 0px; padding: 0px; overflow-wrap: break-word ;"/></section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 14px; color: rgb(136, 136, 136); overflow-wrap: break-word !important; box-sizing: border-box !important;">图1 OGTT试验</span></p><p><br/></p><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">检验案例分析</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">从3月18日此患者的检验报告来看,糖化血红蛋白为10.0%,已表明该患者前三个月血糖平均水平是偏高的,需要控制;但是当天的空腹血糖和餐后两小时血糖水平还处于较正常水平,故未引起患者重视。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">4月17日患者再次以“低血糖“来就诊,血糖及尿糖均已超标,而且出现了酮体;临床医师根据检验结果诊断为糖尿病酮症,并及时进行纠酮治疗,治疗的同时也随时监测血糖及尿糖情况,至尿酮体转为阴性。当体内大量堆积的葡萄糖排出后,进行胰岛、C肽释放试验。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">结果表明:葡萄糖曲线整体偏高,并且高峰延迟在约2小时左右出现;胰岛素曲线同样在2小时左右出现波峰,3小时有所回落,但是胰岛素分泌最高峰约在30<span style="color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify;">μ</span>U/mL,约为空腹值的3倍,可能存在胰岛素分泌相对不足,也可能是由于注射外源性胰岛素所致;而C肽不受外源性胰岛素的影响,更能准确反映胰岛β细胞功能,C肽曲线均维持在较低水平且没有明显波动,因此患者可能存在胰岛素分泌相对不足。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">临床案例分析</span></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)为最常见的糖尿病急症。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">DKA分为几个阶段:</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">早期血酮升高称酮血症,尿酮排出增多称酮尿症,统称为酮症;根据患者的临床症状及血、尿结果可诊断为糖尿病酮症;根据患者OGTT及联合胰岛素、C肽释放试验结果建议其更改降糖方案。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">患者原用药物包括门冬30胰岛素(早餐前20u,晚餐前18u,iH)、阿卡波糖50mg/tid、格列美脲2mg/qd、盐酸二甲双胍片0.5g/tid。由于使用传统药物控制血糖不佳、再结合临床症状综合考虑需更换降糖方案。本病例在原方案基础上加用DPP-4(dipeptidylpeptidase-4,DPP-4)抑制剂西格列汀。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">西格列汀是第一个应用于临床的新型降糖药物。它可抑制DPP对肠促胰岛素激素(GLP-1)的水解,使血液中GLP-1的浓度升高至接近正常人水平。GLP-1促进β细胞的增殖和分化,减少凋亡,保护或修复处于衰退中的β细胞功能,促进胰岛素分泌并增强β细胞的反应性<sup>[2]</sup>。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">在有效性方面,有文献报道通过增加活性肠促胰岛激素水平,西格列汀能够以葡萄糖依赖的方式增加胰岛素释放并降低胰高糖素水平从而降低糖化血红蛋白,并降低空腹血糖和餐后血糖水平<sup>[3]</sup>;联合应用中,其与二甲双胍的作用机制互补、疗效显著被视为黄金搭配<sup>[4]</sup>。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">2013AACE(美国临床内分泌专家组织)已将西格列汀单用或联合作为T2DM治疗的最优选择之一。从安全性考虑,西格列汀可保护肾脏,降低微量蛋白尿。呼双琴等<sup>[5]</sup>研究表明西格列汀治疗组尿液中微量白蛋白水平明显下降,可能与西格列汀能够改善机体炎症状态、降低氧化及应激水平密切相关。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">患者现在具体降糖方案为门冬30胰岛素(早餐前24u,晚餐前24u,iH)、阿卡波糖50mg/tid、盐酸二甲双胍片0.5g/tid、西格列汀为100mg/qd。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">知识拓展</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">糖尿病是以高血糖为主要标志的内分泌代谢性疾病。2型糖尿病(T2DM)是以胰岛素抵抗为主,伴胰岛素分泌不足,至以胰岛素分泌不足为主伴胰岛素抵抗。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">为评估患者的胰岛分泌功能,通常要做“胰岛素释放试验”,其过程是让病人口服葡萄糖或用馒头餐来刺激胰岛β细胞释放胰岛素,分别测定空腹及服糖后半小时、1小时、2 小时、3小时的血糖及胰岛素值,通过分析,来了解患者胰岛β细胞的储备功能及衰竭程度。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">由于无法区分内源性和外源性胰岛素,因此,对正在使用胰岛素的糖尿病患者测定胰岛素来反映胰岛功能显然不行,这种情况下,我们选择测定C肽,其与胰岛素有一个共同的前体——胰岛素原,一个分子的胰岛素原可裂解成一个分子的胰岛素和一个分子的C肽。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">由于肝脏对C肽摄取率低,C肽清除比较慢,所以C肽分子比胰岛素稳定,再加上它不受外源注射胰岛素的影响,故测定C肽更能准确地反映胰岛β细胞功能。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">正常情况下,体内胰岛素分泌是连续而有规律的。进餐后,胰岛β细胞快速释放大量胰岛素,促进肠道吸收的葡萄糖迅速被利用,使餐后血糖水平不至于过度升高;空腹或饥饿时,体内胰岛素的释放量相应减少,维持血糖水平不至于过度降低。正是由于这种灵活的胰岛素分泌方式才使机体血糖得以维持正常。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">糖代谢正常者的胰岛素释放曲线:空腹血浆胰岛素水平约为5-20μU/mL,口服葡萄糖或馒头餐后0.5-1.0h胰岛素分泌达到高峰,峰值约为空腹值的5-10倍(多数为50-100<span style="color: rgb(0, 0, 0); font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 16px; text-align: justify;">μ</span>U/mL),服糖后2-3小时胰岛素逐渐恢复到空腹水平。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">糖代谢正常者的C肽释放曲线:空腹血浆C肽为4-5ng/mL,口服葡萄糖或馒头餐后0.5-1.0h分泌达到高峰,峰值约为空腹值的5-6倍,3-4h逐渐恢复到空腹水平。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">与正常人相比,糖尿病患者在胰岛素分泌基值高低、有无分泌高峰以及峰值出现早晚等方面均有明显不同,分述如下:</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">(1)典型1型糖尿病者的胰岛素、C肽释放曲线</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">1型糖尿病是由于胰岛β细胞严重毁损导致胰岛素绝对缺乏的糖尿病,因此,1型糖尿病患者空腹血浆胰岛素及C肽水平明显低于正常(胰岛素基值一般在5 μU/mL以下),服糖刺激后各时点的胰岛素、C肽数值也无相应增加。释放曲线表现为空腹及服糖后各时点数值低下、无峰值的低平曲线。需要说明的是:这种类型的曲线也可见于胰岛功能趋于衰竭的晚期2型糖尿病患者。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">(2)典型2 型糖尿病者的胰岛素、C肽释放曲线</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">2型糖尿病的发病机制主要是胰岛素抵抗和胰岛素分泌相对不足。因此患者既可以是以“胰岛素抵抗”为主,也可能是以“胰岛素分泌不足”为主。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">“胰岛素抵抗”为主:表现在胰岛素、C肽释放曲线中是空腹胰岛素、C肽水平明显高于正常,糖负荷后释放曲线上升迟缓,其高峰在餐后2-3h出现(分泌高峰后延),在3-4h释放曲线仍然没有回落到空腹水平。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">“胰岛素分泌不足”为主:表现在胰岛素、C肽释放曲线中是空腹胰岛素、C肽水平数值正常或偏低,糖负荷后释放曲线上升迟缓,其高峰在餐后2-3h出现(分泌高峰后延),峰值偏低,3-4h释放曲线也没有回落到空腹水平。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; font-size: 14px; color: rgb(136, 136, 136); overflow-wrap: break-word !important; box-sizing: border-box !important;">表1 正常人和糖尿病患者糖耐量及胰岛素、C肽释放特点</span></p><p label="图注表头" class="ysz-ueditor-head_notes" style="font-size: 14px; color: rgb(136, 136, 136); text-align: center;"><img src="https://studioyszimg.yxj.org.cn/0A00007C017CDB483EF61176521512AC.jpg" style="margin: 0px; padding: 0px; caret-color: red; overflow-wrap: break-word ;"/><br/></p><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">案例总结</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">全面控糖,血糖达标。根据此中年女性10年病程及合并的并发症,糖化血红蛋白HbA<sub>1c</sub>需控制在&lt;7.0%。三月后复查,HbA<sub>1c</sub>6.9%,空腹血糖FPG6.9mmol/L,餐后2小时血糖8.4mmol/L。根据检验结果调整降糖方案获得满意的效果,延缓了糖尿病病程的进展及并发症的发生。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">专家点评</span></section></section></section></section></section></section></section></section></section></section></section></section><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></section></section></section></section><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);">糖尿病是以慢性高血糖为特征的一组代谢性疾病,后期并发症多,病死率及致残率高,严重危害大众健康。由于糖尿病的病因及发病机制尚未完全阐明,缺乏病因治疗。强调治疗须早期和长期、积极而理性以及治疗措施个体化的原则。治疗目标为纠正代谢紊乱,消除症状、防止或延缓并发症的发生。在基层医院有效管理糖尿病患者尤为重要。本案例着手于常见的临床病例,临床症状与适宜的检验项目相结合,及时发现了患者的酮症并发症,并给予相应的治疗及降糖方案,大大延缓了患者的病情发展。</span></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);"><br/></span></p><p style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: center; white-space: normal; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important; font-size: 16px; font-family: &quot;Helvetica Neue&quot;, Helvetica, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; color: rgb(0, 0, 0);"><img src="https://studioyszimg.yxj.org.cn/ajas370liuo.png" title="" alt="" style="max-width:100%;"/></span></p><section style="margin: 0px; padding: 0px; max-width: 100%; font-family: mp-quote, -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; text-align: justify; white-space: normal; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"></section><section style="margin: 0px; padding: 0px; max-width: 100%; line-height: 1.75em; overflow-wrap: break-word !important; box-sizing: border-box !important;"></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><!--auditorInfo--><div class="footer"><div class="item"><p class="ysz-ueditor-references-label" >参考文献 <span>共5篇<i></i></span></p><div class="ysz-ueditor-references-content textLine2" lang="en"><p style="text-align: justify;"><span style="font-size: 16px;">[1]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://pubmed.ncbi.nlm.nih.gov/24524730/.ysz_link&quot;}">CersosimoE,Solis-HerreraC,TrautmannE,et al.Assessment of Pancreatic β-cell function:review of methods and clinical applications.CurrDiabetes Rev,2014,lO:2-42.</span></span></p><p style="text-align: justify;"><span style="font-size: 16px;">[2]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://pubmed.ncbi.nlm.nih.gov/12517256/.ysz_link&quot;}">Drucker DJ. Therapeutic potential of dipeptidy l peptidaseⅣinhibitorsforthe treatment of type 2 diabetes[J]ExpertOpin Investing Drugs,2003;12(1): 87-100.</span></span></p><p style="text-align: justify;"><span style="font-size: 16px;">[3]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://pubmed.ncbi.nlm.nih.gov/?term=Linagliptinversussitagliptin+in+patients+with+type+2+diabetes+mellitus%3Anetwork+meta+analysis+one+randomized+clinical+trials.ysz_link&quot;}">KESHAVARZK,LOTFIF,SANATIE.Linagliptinversussitagliptin in patients with type 2 diabetes mellitus:anetworkmeta-analysis of randomized clinical trials[J].DaruJof Pharm Scien,2017,25(1): 23.</span></span></p><p style="text-align: justify;"><span style="font-size: 16px;">[4]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://xueshu.baidu.com/usercenter/paper/show?paperid=33a39471e3149b22f1f371a8e79453dc&amp;site=xueshu_se.ysz_link&quot;}">黄宾协.西格列汀联合二甲双胍治疗初发糖尿病的临床观察[J].中国医疗前沿,2011;6( 6) : 58.</span></span></p><p style="text-align: justify;"><span style="font-size: 16px;">[5]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_swcx201627033.ysz_link&quot;}">呼双琴,白小岗,李霞,等.西格列汀对2型糖尿病患者微量白蛋白尿影响的研究[J].现代生物医学进展,2016,16(27): 5324-5326.</span></span></p></div></div>

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