足月新生儿高胰岛素血症临床分析

发布时间：2018-03-18 20:41

本文选题：新生儿　切入点：高胰岛素血症　出处：《南京医科大学学报(自然科学版)》2017年12期 　论文类型：期刊论文

【摘要】：目的 :对新生儿高胰岛素血症病例作总结分析,了解此类患儿的临床特点以及转归。方法 :共纳入2011年1月1日—2016年1月1日高胰岛素血症新生儿19例。监测8段血糖,完善胰岛素+C肽、胰高血糖素、皮质醇、生长激素、甲状腺功能、腹部CT平扫等检查。并行临床资料、血尿串联质谱分析、基因测序、头颅磁共振等资料的采集。结果:(1)平均出生体重(3 507.9±542.4)g,胎龄(38.9±3.6)周,起病日龄9.9±7.0 d。其中小于胎龄儿2例,窒息2例。孕母平均年龄(28.1±1.8)岁,妊娠期合并症5例,1例有低血糖家族史。(2)胰岛素2次测定平均值(12.8±3.5)及(12.9±2.8)m U/L,胰岛素/血糖为0.42及0.41。基因筛查发现1例ABCC8基因突变,1例KCNJ11基因突变。(3)活力减低表现最为常见、有8例。静脉所需平均糖浓度(11.8±1.0)%,静脉输注葡萄糖速度(9.7±1.1)mg/kg·min,平均疗程(13.3±2.8)d。应用二氮嗪者11例,平均疗程(7.4±1.6)d。出院前头颅磁共振发现异常改变5例,出院后随访3例合并有脑损伤。(4)二氮嗪与非二氮嗪组比较,胰岛素/血糖比值差异明显(P0.05)。结论:早期多汗、活力减低、呼吸暂停需警惕本病;需应用二氮嗪的患儿其胰岛素/血糖比值较高;对二氮嗪疗效不佳的患儿应注意基因检测;部分住院期间存有脑损伤患儿,随访发现脑损伤可有不同程度改善。
[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 卤542.4 g, gestational age was 38.9 卤3.6 weeks, onset age was 9.9 卤7.0 days. 2 cases were smaller than gestational age and 2 cases were asphyxia. The average age of pregnant mother was 28.1 卤1.8 years old. In 5 cases of gestational complications, 1 case had a family history of hypoglycemia (12.8 卤3.5) and 12.9 卤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 卤1.0g / min, the velocity of intravenous glucose infusion was 9.7 卤1.1 mg / kg 路min, and the average course of treatment was 13.3 卤2.8 days. 11 cases were treated with diazazine, and the average course was 7.4 卤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.
【作者单位】：安徽省妇幼保健院儿科;
【分类号】：R722.1

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