Dahl-Jørgensen K
Aker Diabetes Research Centre, Paediatric Department, Aker University Hospital, Oslo, Norway.
Acta Paediatr Suppl. 1998 Oct;425:31-4. doi: 10.1111/j.1651-2227.1998.tb01249.x.
Microvascular complications of diabetes include retinopathy, nephropathy and neuropathy. The first signs of these complications may develop in children and adolescents, particularly if insulin treatment has been inadequate. The mechanisms by which diabetic microangiopathy develop are not known, but probably include genetic influences. Several biochemical changes may interact, one important change being increased protein glycation. Important functional changes are increased organ blood flow, increased vascular permeability, abnormal blood viscosity and abnormal platelet and endothelial function. The structural hallmark of diabetic microangiopathy is the thickening of the capillary basement membrane. These changes may lead to occlusive angiopathy and to tissue hypoxia and damage. Screening for microangiopathy should start in children and adolescents after 5-y duration of the disease and 10y of age. The screening should include retinal examination through a dilated pupil or fundus photography, urinary albumin excretion rate, blood pressure measurement and neurological examination. Several intervention trials have shown that near normoglycaemia may reduce the risk of microangiopathy. There is a curvilinear association between the risk of development and progression of microangiopathy and mean blood glucose. Therefore, optimal insulin treatment is important in children and adolescents.
糖尿病的微血管并发症包括视网膜病变、肾病和神经病变。这些并发症的最初迹象可能在儿童和青少年中出现，尤其是胰岛素治疗不充分时。糖尿病微血管病变的发病机制尚不清楚，但可能包括遗传因素。几种生化变化可能相互作用，其中一个重要变化是蛋白质糖基化增加。重要的功能变化包括器官血流量增加、血管通透性增加、血液粘度异常以及血小板和内皮功能异常。糖尿病微血管病变的结构特征是毛细血管基底膜增厚。这些变化可能导致闭塞性血管病以及组织缺氧和损伤。对于微血管病变的筛查应在儿童和青少年患病5年且年龄达10岁后开始。筛查应包括散瞳后的视网膜检查或眼底照相、尿白蛋白排泄率、血压测量以及神经学检查。多项干预试验表明，接近正常血糖水平可能降低微血管病变的风险。微血管病变发生和进展的风险与平均血糖之间存在曲线关联。因此，优化胰岛素治疗对儿童和青少年很重要。
