Elevated Plasma β-Hydroxybutyrate Concentrations without Ketonuria in Healthy Insulin-Dependent Diabetic Patients*
Elevated Plasma β-Hydroxybutyrate Concentrations without Ketonuria in Healthy Insulin-Dependent Diabetic Patients*
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健康胰岛素依赖型糖尿病患者血浆 β-羟基丁酸浓度升高但无酮尿*
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发表时间：
1982
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影响因子：
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通讯作者：
P. Schaefer
中科院分区：
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作者：
M. Macgillivray;Philip K. Li;Josephine T. Lee;B. Mills;M. Voorhess;T. I. Putnam;P. Schaefer
在一项为期 24 小时的研究中，对 10 名健康的胰岛素依赖型糖尿病患者进行血浆 β-羟基丁酸 (β-OHB) 浓度和同步尿酮尿（硝普钠反应）检测，每 4 小时进行一次评估，这些患者根据家庭尿检和血红蛋白 A1C 升高控制不佳。同时测量了糖尿病组和 20 名年龄匹配受试者的对照人群中的主要碳水化合物调节激素。在糖尿病患者中，73% 的 β-OHB 测量值升高。只有 43% 的异常 β-OHB 值与酮尿有关。糖尿病受试者还表现出血浆 β-OHB 和皮质醇的昼夜变化模式。糖尿病组和正常组中的其他调节激素没有显着差异。我们的结论是：1）控制不佳的糖尿病患者普遍存在血浆 β-OHB 水平异常但无酮尿症； 2) 硝普钠酮尿试验阴性，由于 β-OHB 浓度升高，低估了酮血症的存在； 3）胰岛素缺乏和糖皮质激素过量都可能影响胰岛素依赖型糖尿病患者的酮体代谢。
Plasma beta-hydroxybutyrate (beta-OHB) concentrations and simultaneous urine tests for ketonuria (nitroprusside reaction) were evaluated every 4 h throughout a 24-h study in 10 healthy insulin-dependent diabetics who had poor control based on home urine tests and elevated hemoglobin A1C. Concurrent measurements of the major carbohydrate regulatory hormones were made in the diabetic group and in a control population of 20 age-matched subjects. In the diabetics, 73% of the beta-OHB measurements were elevated. Only 43% of the abnormal beta-OHB values were associated with ketonuria. The diabetic subjects also showed exaggerated diurnal patterns for plasma beta-OHB and cortisol. There were no significant differences for the other regulatory hormones in the diabetic and normal groups. We conclude that 1) abnormal plasma beta-OHB levels without ketonuria are prevalent in poorly controlled diabetics; 2) negative nitroprusside tests for ketonuria underestimate the presence of ketonemia due to increased beta-OHB concentrations; 3) both insulin deficiency and glucocorticoid excess may influence ketone body metabolism in insulin-dependent diabetic patients.