GENDER INFLUENCES COUNTERREGULATORY HORMONE RESPONSES TO HYPOGLYCEMIA
GENDER INFLUENCES COUNTERREGULATORY HORMONE RESPONSES TO HYPOGLYCEMIA
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DOI：
10.1016/0026-0495(93)90152-e
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发表时间：
1993-12-01
影响因子：
9.8
通讯作者：
SHERWIN, RS
中科院分区：
文献类型：
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作者：
DIAMOND, MP;JONES, T;SHERWIN, RS
一般认为，低血糖的反调节激素反应不受性别的影响。为了验证这一假设，我们分析了年龄匹配的健康非肥胖女性（n = 33）和男性（n = 37）的三项独立的低血糖胰岛素钳夹研究。在一项研究（12名女性，17名男性）中，采用0.65 mU/kg/min胰岛素输注，血糖水平迅速降至约57 mg/dL，持续100分钟。尽管葡萄糖水平同样下降，肾上腺素水平的增加（361 ± 64 v188 ± 38 pg/mL，P< .05），去甲肾上腺素（132 ± 28 v47 ± 19 pg/mL，P<0.01），生长激素（[GH] 16.0 ± 3.8v4.9 ± 1.9 ng/mL，P<0.05），但胰高血糖素或皮质醇水平在男性中分别显著高于女性。在第二项研究（10只雌性，8只雄性）中，使用5.0 mU/kg/min胰岛素输注将葡萄糖水平降至55 mg/dL，持续180分钟。肾上腺素（P<0.05）和GH（P<0.01）反应在男性比女性更大。在第三项研究（11名女性，12名男性）中，血糖水平在240分钟内逐渐降低至约50 mg/dL。肾上腺素（P<0.01）、去甲肾上腺素（P<0.01）、GH（P<0.05）和皮质醇（P<0.01）的反应在男性中几乎是两倍（P<0.01）。对所有70名受试者进行的多变量分析表明，性别是影响肾上腺素（P<0.001）和去甲肾上腺素（P<0.005）反应的最重要因素，也是影响GH反应的重要因素（P<0.05）。此外，男性中触发肾上腺素、去甲肾上腺素和皮质醇增加的葡萄糖水平分别高出约9 mg/dL（P<0.05）。我们的结论是，相对于男性，女性低血糖的反调节激素反应降低。这种两性异形可能部分是由于激素释放的葡萄糖阈值的改变。
It has been generally assumed that counterregulatory hormone responses to hypoglycemia are not influenced by gender. To test this assumption, we analyzed three separate hypoglycemic insulin clamp studies in age-matched, healthy, non-obese females (n = 33) and males (n = 37). In one study (12 females, 17 males), plasma glucose level was rapidly decreased to about 57 mg/dL for 100 minutes with a 0.65-mU/kg/min insulin infusion. Despite an identical decrease in glucose level, the increase in epinephrine (361 ± 64v188 ± 38 pg/mL,P< .05), norepinephrine (132 ± 28v47 ± 19 pg/mL,P< .01), and growth hormone ([GH] 16.0 ± 3.8v4.9 ± 1.9 ng/mL,P< .05) levels, but not glucagon or cortisol levels, were significantly greater in males than in females, respectively. In the second study (10 females, eight males), a 5.0-mU/kg/min insulin infusion was used to decrease glucose levels to 55 mg/dL for 180 minutes. Epinephrine (P< .05) and GH (P< .01) responses were greater in males than in females. In a third study (11 females, 12 males), plasma glucose level was gradually decreased to about 50 mg/dL over 240 minutes. Again epinephrine (P< .01), norepinephrine (P< .01), GH (P< .05), and cortisol (P< .01) responses were nearly twofold greater in males (P< .01). Multivariate analysis of all 70 subjects identified gender as the most significant factor contributing to the epinephrine (P< .001) and norepinephrine (P< .005) responses, and also as a significant contributor to the GH response (P< .05). Moreover, the glucose levels that triggered an increase in epinephrine, norepinephrine, and cortisol were each about 9 mg/dL higher in males (P< .05). We conclude that, with respect to males, females have decreased counterregulatory hormonal responses to hypoglycemia. This sexual dimorphism may be in part due to an alteration in the glucose threshold for hormone release.