为什么尿糖不能用于糖尿病诊断...

2022-08-01 检验医学 检验医学

一探究竟~

尿糖“+”≠糖尿病

图片

糖尿病最新诊断标准

糖尿病,顾名思义,很多人会简单地认为尿糖出现即等同于糖尿病,殊不知:尿液中理化成分极易受糖摄入量、饮水量多少、药物、机体应激状态、肾脏功能等诸多因素影响而产生变化,所以无论是居家使用尿糖试条或是来医院做的尿常规检测,均不能准确反映机体糖代谢的真实状况,所以偶然出现的一次尿糖“+”,大可不必过分紧张,因为仅凭此一项,是不能拿来诊断糖尿病的。

尿糖检测的不足

1.肾糖阈影响

正常情况下,血液中经肾小球滤过的葡萄糖,几乎全部在近端肾小管被重吸收入血,终尿含糖量极少,一般方法常检测不出,故尿糖阴性。当血糖浓度超过一定限度时,肾小球滤出葡萄糖超出肾小管重吸收能力时,尿中可出现尿糖,即尿糖阳性。所谓“肾糖阈”,即指尿中开始出现葡萄糖时最低的血糖浓度,通常为8.9-10.0亳摩/升。由此可见,尿糖阳性,不仅关乎血糖,还时刻受到肾脏滤过及重吸收功能的影响,如果肾脏出现了问题,或存在一些先天遗传性因素导致肾糖阈降低,如:良性家族性肾性糖尿,范可尼综合征等合并有肾小管功能障碍性疾病,即便病人空腹及餐后血糖正常,由于肾脏对糖重吸收不足,也能够导致尿糖。

2.不能即刻反映血糖水平

尿糖检测反映的是尿液潴留于膀胱中这段时间内的平均血糖水平,如果糖尿病病人同时伴有膀胱自主神经病变,则导致新生成尿液与潴留尿液混合,导致尿糖检查出现偏差。

3.干扰因素多

(1)尿标本存放时间过长会导致细菌繁殖增快,消耗尿中葡萄糖,使得结果偏低或出现假阴性;(2)短时间内摄入过多高糖食物,会在尿液中排出相应物质,造成假阳性;(3)样本采集过程中,受到过氧化氢、次氯酸等氧化剂影响,可导致试带法假阳性。

4.不能定量

尿糖检测多为半定量检测,阴性时不能区分低血糖、正常血糖及轻度高血糖。

餐后低血糖

与大家惯常的思维有所不同,吃完饭本应该血糖增高才对,但由于胰岛素释放滞后或食物刺激后,分泌过高,就能够引发餐后低血糖,这又是怎么一回事呢?

餐后低血糖又名反应性低血糖,多发于年轻女性,临床常表现为发作性乏力、心慌、出汗、意识朦胧等,摄入过量精制单糖或寡糖类食物和饮酒史为其常见诱发因素,常见疾病包括:

(1)垂体和肾上腺皮质功能不全早期;

(2)2型糖尿病初期病人胰岛素快速分泌障碍,胰岛素释放延迟,葡萄糖耐量试验中表现出的早期高血糖,继之发生的迟发性低血糖;

(3)特发性反应性低血糖,或与胰高血糖素受体降解及受体敏感性下降有关。

职考真题直击

1不属于血糖増高性糖尿的是(2013初级师)

A.糖尿病

B.库欣综合征

C.嗜铬细胞瘤

D.家族性糖尿

E.甲状腺功能亢进  

2患者男,56岁。体质肥胖,因口干、乏力、右足趾麻木1年入院。查体:血压138/78mmHg,脉搏80次/分,呼吸22次/分,血糖16mmol/L ,尿糖(+++),尿蛋白(-),尿酮体(-),血尿酸310umol/L ,患者最可能的诊断是(2015初级师)

A.1型糖尿病

B.2型糖尿病

C.痛风性关节炎

D.高脂蛋白血症

E.原发性高血压

答案:D、B

参考文献

1.中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021, 13(4):95.

2.屈春梅,杨刚毅.致低血糖症的原因综述[J].临床误诊误治,2004(3):163-166.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1645932, encodeId=7d9a164593202, content=<a href='/topic/show?id=64644e490b0' target=_blank style='color:#2F92EE;'>#尿糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47490, encryptionId=64644e490b0, topicName=尿糖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bce523261420, createdName=liubm563, createdTime=Fri Mar 24 22:23:40 CST 2023, time=2023-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236467, encodeId=bf31123646edc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed Aug 03 22:46:11 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236172, encodeId=a63612361e242, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d838244645, createdName=ms2000000729194157, createdTime=Tue Aug 02 16:13:17 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235928, encodeId=fe9b1235928d9, content=认真看收获很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a818165113, createdName=ms8000001437668740, createdTime=Mon Aug 01 12:51:46 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2023-03-24 liubm563
  2. [GetPortalCommentsPageByObjectIdResponse(id=1645932, encodeId=7d9a164593202, content=<a href='/topic/show?id=64644e490b0' target=_blank style='color:#2F92EE;'>#尿糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47490, encryptionId=64644e490b0, topicName=尿糖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bce523261420, createdName=liubm563, createdTime=Fri Mar 24 22:23:40 CST 2023, time=2023-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236467, encodeId=bf31123646edc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed Aug 03 22:46:11 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236172, encodeId=a63612361e242, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d838244645, createdName=ms2000000729194157, createdTime=Tue Aug 02 16:13:17 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235928, encodeId=fe9b1235928d9, content=认真看收获很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a818165113, createdName=ms8000001437668740, createdTime=Mon Aug 01 12:51:46 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-08-03 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1645932, encodeId=7d9a164593202, content=<a href='/topic/show?id=64644e490b0' target=_blank style='color:#2F92EE;'>#尿糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47490, encryptionId=64644e490b0, topicName=尿糖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bce523261420, createdName=liubm563, createdTime=Fri Mar 24 22:23:40 CST 2023, time=2023-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236467, encodeId=bf31123646edc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed Aug 03 22:46:11 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236172, encodeId=a63612361e242, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d838244645, createdName=ms2000000729194157, createdTime=Tue Aug 02 16:13:17 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235928, encodeId=fe9b1235928d9, content=认真看收获很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a818165113, createdName=ms8000001437668740, createdTime=Mon Aug 01 12:51:46 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-08-02 ms2000000729194157

    学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1645932, encodeId=7d9a164593202, content=<a href='/topic/show?id=64644e490b0' target=_blank style='color:#2F92EE;'>#尿糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47490, encryptionId=64644e490b0, topicName=尿糖)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bce523261420, createdName=liubm563, createdTime=Fri Mar 24 22:23:40 CST 2023, time=2023-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236467, encodeId=bf31123646edc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Wed Aug 03 22:46:11 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236172, encodeId=a63612361e242, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d838244645, createdName=ms2000000729194157, createdTime=Tue Aug 02 16:13:17 CST 2022, time=2022-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1235928, encodeId=fe9b1235928d9, content=认真看收获很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5a818165113, createdName=ms8000001437668740, createdTime=Mon Aug 01 12:51:46 CST 2022, time=2022-08-01, status=1, ipAttribution=)]
    2022-08-01 ms8000001437668740

    认真看收获很多

    0

相关资讯

2型糖尿病的健康管理权威专家共识出台!

我国体育科学、康复科学和医学领域等专家组成的专家组,组织制定了《运动联合营养缓解2型糖尿病的专家共识》

Cardiovasc Diabetol:急性心肌梗死后糖尿病患者和非糖尿病患者入院后高血糖的短期和长期预后

众所周知,糖尿病是心血管疾病患者的常见共病。急性心肌梗死和糖尿病患者的短期和长期死亡率比非糖尿病患者高两倍以上。

Clin Epigenetics:非裔美国人胰岛素抵抗的表观基因组关联研究

胰岛素抵抗是T2D的一个主要特征,据报道,相对于欧洲血统的美国人,非洲裔美国人的胰岛素抵抗程度更高。

JCEM:启动二线治疗后2型糖尿病患者3年来治疗满意度的变化

糖尿病的治疗目标是预防与糖尿病相关的并发症的发生或恶化,包括微血管和大血管并发症,以及改善患者的生活质量

FRBM:急性缺血性中风合并糖尿病患者炎症反应紊乱,Resolvin D2治疗可挽救炎症反应

炎症已被证明在糖尿病的病理生理学及其并发症中起着关键作用,包括AIS。

Antioxidants:使用遗传风险评分和氧化应激评分早期预测糖尿病前期和2型糖尿病

糖尿病前期被认为是关键阶段,因为研究表明,糖尿病前期的治疗可以预防或减少糖尿病和糖尿病相关并发症的进一步发展。