中国实用儿科杂志

中国实用儿科杂志

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低血糖症患儿胰高血糖素水平的研究

  

  1. 首都儿科研究所附属儿童医院内分泌科，北京  100045
  • 出版日期:2021-06-06 发布日期:2021-07-08

A  study on serum glucagon level in hypoglycemia children

  1. Department of Endocrinology， Children’s Hospital Affiliated to Capital Institute of Pediatrics， Beijing  100045， China
  • Online:2021-06-06 Published:2021-07-08

摘要： 目的　分析不同病因低血糖症患儿胰高血糖素的分泌能力及低血糖发生时的反应能力。方法　收集首都儿科研究所附属儿童医院内分泌科2020年3月至2021年3月收治的低血糖症患儿资料，对其数据进行分析。其中先天性高胰岛素血症11例，特发性酮症性低血糖30例，对照组30例（行胰岛素诱发低血糖试验的特发性矮小患儿）；测定其低血糖发作时及血糖正常时血清胰高血糖素的水平。分组比较低血糖及血糖正常时血清胰高血糖素水平，分析不同病因的低血糖症患儿的胰高血糖素分泌能力及低血糖发生时的反应能力。结果　先天性高胰岛素血症患儿在低血糖发作时与血糖正常时相比较，血清胰高血糖素分泌明显升高［（146.18±44.93） ng/L vs. （133.02±37.89） ng/L］，差异有统计学意义。特发性酮症性低血糖患儿低血糖发作时与血糖正常时相比较，血清胰高血糖素水平未见明显升高［（133.47±54.29） ng/L vs. （129.23±44.60） ng/L］，差异无统计学意义。对照组儿童诱发低血糖时及血糖正常时相比较，低血糖时血清胰高血糖素更低，差异有统计学意义。先天性高胰岛素血症和特发性酮症性低血糖患儿比较，正常血糖和低血糖时胰高血糖素水平差异均无统计学意义。结论　先天性高胰岛素血症患儿胰高血糖素的分泌能力及低血糖时反应能力均无受损。特发性酮症性低血糖患儿胰高血糖素分泌能力正常，低血糖时反应能力不足。外源性胰岛素会抑制胰高血糖素分泌。

关键词: 低血糖症, 胰高血糖素, 先天性高胰岛素血症, 特发性酮症性低血糖

Abstract: Objective　To analyze the glucagon secretion and reaction ability of hypoglycemia children with different etiologies. Methods　The child patients with hypoglycemia of Children’s Hospital Affiliated to Capital Institute of Pediatrics in March 2020 to March 2021 were included，and their data were analyzed，including 11 patients with congenital hyperinsulinemia，30 cases of idiopathic ketosis hypoglycemia and 30 cases as control group（the children with idiopathic short stature receiving insulin-induced hypoglycemia test）. Serum glucagon levels were measured during episodes of hypoglycemia and under normal glucose. The serum glucagon levels of hypoglycemia and normal blood glucose were compared to analyze the secretion capacity of glucagon and the response capacity of hypoglycemia in children with different causes. Results　Compared with normal blood glucose，the serum glucagon secretion of children with congenital hyperinsulinemia was significantly increased during hypoglycemia［（146.18±44.93） ng/L vs. （133.02±37.89） ng/L］ and the difference was statistically significant. Compared with normal glucose children with idiopathic ketosis hypoglycemia，serum glucagon level was not significantly increased［（133.47±54.29） ng/L vs. （129.23±44.60） ng/L］，and the difference was not statistically significant. Compareing the control group when hypoglycemia was induced with that when the blood glucose was normal，the serum glucagon was lower when hypoglycemia was induced，and the difference was statistically significant. There was no significant difference in glucagon level between children with congenital hyperinsulinemia and idiopathic ketosis hypoglycemia during hypoglycemia or under normal glucose. Conclusion　The ability to secrete glucagon and respond to hypoglycemia is not impaired in children with congenital hyperinsulinemia. In children with idiopathic ketogenic hypoglycemia，glucagon secretion is normal，but glucagon response capacity is insufficient in hypoglycemia. Exogenous insulin can inhibit glucagon secretion.

Key words: hypoglycemia, glucagon, congenital hyperinsulinemia, idiopathic ketogenic hypoglycemia