本文選題：新生兒　切入點(diǎn)：高胰島素血癥　出處：《南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版)》2017年12期 　論文類型：期刊論文

【摘要】：目的 :對(duì)新生兒高胰島素血癥病例作總結(jié)分析,了解此類患兒的臨床特點(diǎn)以及轉(zhuǎn)歸。方法 :共納入2011年1月1日—2016年1月1日高胰島素血癥新生兒19例。監(jiān)測(cè)8段血糖,完善胰島素+C肽、胰高血糖素、皮質(zhì)醇、生長(zhǎng)激素、甲狀腺功能、腹部CT平掃等檢查。并行臨床資料、血尿串聯(lián)質(zhì)譜分析、基因測(cè)序、頭顱磁共振等資料的采集。結(jié)果:(1)平均出生體重(3 507.9±542.4)g,胎齡(38.9±3.6)周,起病日齡9.9±7.0 d。其中小于胎齡兒2例,窒息2例。孕母平均年齡(28.1±1.8)歲,妊娠期合并癥5例,1例有低血糖家族史。(2)胰島素2次測(cè)定平均值(12.8±3.5)及(12.9±2.8)m U/L,胰島素/血糖為0.42及0.41。基因篩查發(fā)現(xiàn)1例ABCC8基因突變,1例KCNJ11基因突變。(3)活力減低表現(xiàn)最為常見(jiàn)、有8例。靜脈所需平均糖濃度(11.8±1.0)%,靜脈輸注葡萄糖速度(9.7±1.1)mg/kg·min,平均療程(13.3±2.8)d。應(yīng)用二氮嗪者11例,平均療程(7.4±1.6)d。出院前頭顱磁共振發(fā)現(xiàn)異常改變5例,出院后隨訪3例合并有腦損傷。(4)二氮嗪與非二氮嗪組比較,胰島素/血糖比值差異明顯(P0.05)。結(jié)論:早期多汗、活力減低、呼吸暫停需警惕本病;需應(yīng)用二氮嗪的患兒其胰島素/血糖比值較高;對(duì)二氮嗪療效不佳的患兒應(yīng)注意基因檢測(cè);部分住院期間存有腦損傷患兒,隨訪發(fā)現(xiàn)腦損傷可有不同程度改善。
[Abstract]:Objective: to summarize and analyze the clinical characteristics and outcome of hyperinsulinemia neonates. Methods: 19 cases of hyperinsulinemia neonates from January 1st 2011 to January 1st 2016 were included in this study. Complete insulin C-peptide, glucagon, cortisol, growth hormone, thyroid function, abdominal CT plain scan, clinical data, hematuria tandem mass spectrometry, gene sequencing, Results the average birth weight was 3 507.9 鹵542.4 g, gestational age was 38.9 鹵3.6 weeks, onset age was 9.9 鹵7.0 days. 2 cases were smaller than gestational age and 2 cases were asphyxia. The average age of pregnant mother was 28.1 鹵1.8 years old. In 5 cases of gestational complications, 1 case had a family history of hypoglycemia (12.8 鹵3.5) and 12.9 鹵2.8 渭 / L, insulin / glucose ratio were 0.42 and 0.41 respectively. One case of ABCC8 gene mutation and one case of KCNJ11 gene mutation. There were 8 cases. The average concentration of glucose needed by vein was 11.8 鹵1.0g / min, the velocity of intravenous glucose infusion was 9.7 鹵1.1 mg / kg 路min, and the average course of treatment was 13.3 鹵2.8 days. 11 cases were treated with diazazine, and the average course was 7.4 鹵1.6 d. 5 cases were found abnormal changes in cranial MRI before discharge. After discharge, 3 cases with brain injury were followed up. Compared with non-diazazine group, the difference of insulin / blood glucose ratio was significant (P 0.05). Conclusion: in the early stage, hyperhidrosis, decreased activity, apnea should be alert to this disease. The ratio of insulin to blood glucose was higher in children who needed diazazine; gene detection should be paid attention to in children with poor diazazine efficacy; some children with brain injury had brain injury during hospitalization and the follow-up showed that brain injury could be improved in varying degrees.
【作者單位】： 安徽省婦幼保健院兒科;
【分類號(hào)】：R722.1

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