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1、病例Case1:A11yearoldgirlisbroughttohospital.Shehaslostalmost4kgoverthepastmonthandahalfdespitebeinghungryandovereating.Shealsowasexcessivelythirstyandhasavoluminousurineoutput(polyuria).Physicalexamination:Sheisathinlittlegirl.BP:85/50;pulse:105.Laboratorytests:
2、bloodglucose:40mmol/L(Normal:3.9-6.1mmol/L).Urine:5%glucose.Shehadlittle-cellfunctioninpancreas.Diagnosis:IDDM.Astreatment,insulinwasadministeredtothegirl.Withinsulininjections,thepatienthasbeenapparentlycontrolled.1Case2:A53-year-oldmanhadbeeningoodhealthunt
3、ilabouttwomonthsagowhenhestartedtofeelweakandtiredmorerapidlythanusual.Onquestioning,headmittedtogettinguptwoorthreetimesanighttourinate.Healsoisoftenthirstyatthosetimesanddrinksaglassofwatereachtime.Hehadgraduallygainedweightovertheyears.Hisappetiteremainedex
4、cellentbuthenowwaslosingweightandbecomingweak.Thepaininhisfeetwasworseatnightandsometimeskepthimawake.Itwasburningincharacterandsometimeshistoesfeltnumb.Hisvisionwasblurryattimes,especiallyintheafternoon.2Physicalexamination:obese,pulse76,regular,BP142/78.Feet
5、:skindrywithcallusesonthemedialsideofthebigtoes,Nailsnormal.Laboratorytests:randombloodglucose:25.3mmol/l,glycohemoglobin(HbA1c)16.4%,urinalysis:4+glucose.Diagnosis:NIDDM.ThedoctorprescribedAmaryl(glimepiride,stimulatetheisletcellsinthepancreastoproducemoreins
6、ulin),4mg.aday.Otherclassesoforaldiabetesagentsare:Biguanides(decreasesthereleaseofglucosebytheliver,andmakesothercellsmoresensitivetoinsulin),Thiazolidinediones(TZDs)(increasescellularsensitivitytoinsulinanddecreasesthereleaseofglucosebytheliver).3Dysfunction
7、ofcellularsignaltransductionindisease细胞信号传导异常与疾病华中科技大学同济医学院病理生理系4细胞信号转导指细胞通过胞膜或胞内受体感受信息分子的刺激，经细胞内信号转导系统转换,从而影响细胞生物学功能的过程5细胞信号转导紧密连接细胞:间隙连接:电兴奋传递膜结合信号分子:粘附分子有距离的细胞:内分泌旁分泌自分泌突触信号传递(50nm)6细胞信号物理刺激信号化学信号(配体)体液因子,气体分子,药物,细胞代谢物其它:细胞粘附分子7Generalprocessfor transmembra
8、nesignaltransduction89细胞信号转导的主要途径G蛋白介导的细胞信号转导途径Ga腺苷酸环化酶途径Gi抑制腺苷酸环化酶活性GqIP3、Ca2+-钙调蛋白激酶途径DG-蛋白激酶C途径其他:10111213非G蛋白介导的细胞信号转导途径受体酪氨酸蛋白激酶途径非受体酪氨酸蛋白激酶途径鸟苷酸环化酶信号转导途径核受体及其信号转导途径14Receptor
