NSEC Symposium (Presentation III 01 Chiangrai Kunming Impact)
Zhang Zongji Department of Pathology Kunming Medical College.
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Transcript of Zhang Zongji Department of Pathology Kunming Medical College.
Zhang Zongji Zhang Zongji Department of PathologyDepartment of PathologyKunming Medical CollegeKunming Medical College
OVERVIEWOVERVIEW
Characteristic feature is hyperglycemia and glycosuria. Injury of many organs occur in long-standing diabetes.
Genetic predisposition
Environmental insult
Deficiency in InsulinDeficiency in Insulin
Target-tissue resistanceTarget-tissue resistance
Disorder of metabolism in glucose, protein and fat
Chronic
Disorder Destruction of pancreatic islet
Destruction of pancreatic islet
CLACIFICATION
Primary diabetes mellitusPrimary diabetes mellitus
Insulin-dependent diabetes mellitus, Insulin-dependent diabetes mellitus, IDDMIDDM
Secondary diabetes mellitusSecondary diabetes mellitus
Non-Insulin-dependent diabetes Non-Insulin-dependent diabetes mellitus, mellitus, NIDDMNIDDM
Arise from any diseases causing extensive destruction of pancreatic islet
Special types of diabetes mellitusSpecial types of diabetes mellitusGestational diabetes mellitusGestational diabetes mellitus
Insulin-dependent diabetes mellitusInsulin-dependent diabetes mellitus IDIDDMDM TYPEⅠor Juvenile-onset diabetes
HLA genesHLA genes
virusvirus
Beta cellBeta cell
insulininsulin
IDDMIDDM
Genetic Susceptibility : 6p21— MHC- Ⅱ ( HLA-DP , DQ , DR )
autoimmunityautoimmunity
TypeⅠA and TypeⅠB
Non-Insulin-dependent diabetes mellitusNon-Insulin-dependent diabetes mellitus NIDDMNIDDM TYPEⅡor adult-onset diabetes
90% ~ 95%
环境因素
中国人相关基因中国人相关基因 胰岛素受体基因 载脂蛋白 AI 及 B 基因 葡萄糖激酶 (GCK) 基因
ObesityObesity
多基因变异多基因变异 PPARγ ARNT PTPN1
对胰岛素抵抗
性
胰岛素分泌紊乱
遗传易感性
B
细胞缺
陷
葡萄糖不适当利用
NIDDMNIDDM
Hyperglycemia
两个基本因素 两个基本环节
IDDM NIDDM 基 因 HLA-D相关 多基因缺陷,HLA-D无关
发病机制 自身免疫 胰岛素抵抗
病毒感染 胰岛素分泌紊乱
胰岛细胞 早期胰岛炎 无胰岛炎
显著萎缩和纤维化 局部萎缩和淀粉样变性
严重 B细胞耗竭 中度 B细胞耗竭
临 床 多见儿童 多见成人
正常体重 肥胖
血胰岛素降低 血胰岛素正常或增高
抗胰岛细胞抗体(+) 抗胰岛细胞抗体(—)
常见酮症 罕见酮症
1. 1. Pancreatic isletPancreatic islet
Leukocytic infiltration( A)ⅠReduction in the number and size of islet(Ⅰ )
Beta-cell degranulation(Ⅰ A) Hyaline(Ⅰ ) and Amyloid (Ⅱ ) replacement of islet
Not specific Ⅰ>Ⅱ
Vascular systemVascular system
Vessels of all sizes are affected
Atherosclerosis
Myocadial Myocadial infarctioninfarction
Diabetes microangiopathy:
Diffuse thickening Diffuse thickening of basement of basement membranesmembranes
Diabetic nephropathyDiabetic nephropathy
Glomerular lesionsRenal vascular leisionsPyelonephritis
Renal failure
Diabetic ocular complicationDiabetic ocular complication
Retinopathy
Cararact Glaucoma
nonproliferativeproliferative
BlindnessBlindness
CLINICAL FEATURES
Hyperglycemia Hyperglycemia andand glycosuria glycosuria““ 三多一少”:三多一少”:
Polyuria Polyphagia Polydipsia Loss of weight
KetoacidosisKetoacidosisLate complicationLate complication
AtherosclerosisAtherosclerosis
Susceptibility to infectionsSusceptibility to infections
Myocardial infarctionStroke (cerebrovascular accidents)Gangrene of the legRenal failure Atherosclerotic heart disease
CAUSE OF DEATH: