中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (05): 364-367.

• 论著 • 上一篇    下一篇

格列本脲治疗新生儿糖尿病4例分析

李秀珍，刘    丽，盛慧英，范莉萍，程    静，张    文，毛晓健，蔡   

  1. 广州市妇女儿童医疗中心内分泌代谢科，广州 510623
  • 出版日期:2012-05-06 发布日期:2012-05-30
  • 基金资助:

    广州市科技局支撑项目（2010J-E231-1）；广东省卫生厅资助项目（A2011486）

Effect of glibenclamide treatment on 4 Chinese patients with neonatal diabetes mellitus.

  • Online:2012-05-06 Published:2012-05-30

摘要：

摘要：目的    观察格列本脲治疗新生儿糖尿病（NDM）的疗效。方法    收集2010年4月至2011年1月于我院收治并确诊为NDM的4例患儿临床资料，对其进行用格列本脲替代胰岛素治疗的前瞻性研究，分析用格列本脲治疗NDM的方法及疗效，并进行KCNJ11基因和ABCC8基因分析。结果    4例患儿出生体重2.5 ~ 3.0 kg，就诊年龄3 d至2个月，来诊时血糖均明显升高（30.5 ~ 45.3 mmol/L），均伴有酮症酸中毒。入院后均给予胰岛素治疗，酮症酸中毒纠正，血糖降至15 mmol/L以下时，给予格列本脲替换胰岛素治疗，其中2例（50%）格列本脲用量分别为每天0.5 mg/kg及0.6 mg/ kg时可完全停用胰岛素。随访至观察截止日分别为9个月及7个月，均仍然需服用格列本脲每天0.3 mg/kg，血糖基本正常，未见明显副反应发生。例 2患儿的KCNJ11基因中发现一个突变（R201H），其余3例未发现突变。结论    部分NDM患儿应用格列本脲治疗有效，可免除胰岛素注射的痛苦，因此对确诊NDM的患儿应试用本药治疗；同时对NDM患儿应进行KCNJ11基因和ABCC8基因分析，有助于本病临床预后的判断。

关键词: 新生儿糖尿病, 格列本脲, 治疗

Abstract:

Abstract：Objective    To assess the effect of glibenclamide treatment on patients with neonatal diabetes mellitus （NDM）. Methods    Clinical data of 4 cases （ male 1 case，female 3 cases） of NDM admitted to Guangzhou Women and Children’s Medical Center from Apr. 2010 to Jan. 2011 were analyzed and the treatment methods and effects of glibenclamide on NDM was evaluated. KCNJ11and ABCC8 gene mutations were also searched in these 4 cases.  Results   The birth weight of 4 cases was 2.5 ~ 3.0 kg and the diagnosis time from 3 days to 1 month. All of them presented with severe hyperglycemia（30.5 ~ 45.3 mmol/L）and ketoacidosis and were treated with insulin infusion. They switched from insulin to oral glibenclamide when their glucose was stable. Two patients （50%） successfully discontinued insulin after receiving glibenclamide and the dose was 0.5 mg/（kg·d） and 0.6 mg/（kg·d） respectively. They were followed up for 9 months and 7 months， still receiving glibenclamide 0.3 mg/（kg·d）to keep their blood glucose within normal range. No obvious side effects occurred. A KCNJ11 （R201H）mutation was found in 1 case who could  successfully switched to  glibenclamide，but no mutation was found in the other 3 cases. Conclusion    Glibenclamide therapy is effective in some patients with NDM and may successfully discontinue insulin injection，especially in those with KCNJ11 mutation.

Key words: neonatal diabetes mellitus, glibenclamide, treatment