PANCREAS TRANSPLANTATION IN DIABETIC HUMANS NORMALIZES HEPATIC GLUCOSE-PRODUCTION DURING HYPOGLYCEMIA
PANCREAS TRANSPLANTATION IN DIABETIC HUMANS NORMALIZES HEPATIC GLUCOSE-PRODUCTION DURING HYPOGLYCEMIA
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DOI：
10.2337/diabetes.43.5.661
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发表时间：
1994-05-01
期刊：
影响因子：
7.7
通讯作者：
ROBERTSON, RP
中科院分区：
文献类型：
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作者：
BARROU, Z;SEAQUIST, ER;ROBERTSON, RP
虽然1型糖尿病患者成功的胰腺移植可以恢复葡萄糖诱导的胰岛素分泌，使其摆脱胰岛素治疗，并使空腹血糖水平正常化，但对其对低血糖的反调节作用知之甚少。为了确定胰腺移植是否能使低血糖期间胰高血糖素分泌和肝糖生成（HGP）正常化，我们对成功接受同种异体胰腺移植的患者进行了高胰岛素降糖钳。在低血糖期间，受体的胰高血糖素分泌反应与对照组相似（胰高血糖素增量反应：受体，147 +/- 34 ng/L；对照组，161 +/- 43 ng/L， NS），但显著高于匹配的1型糖尿病患者（23 +/- 9 ng/L, P < 0.01）。在120分钟低血糖结束时，受体和对照组的HGP率也显著高于糖尿病患者(胰腺受体，1.92 +/- 0.33 mg kg(-1) min(-1)；对照组：2.05 +/- 0.18 mg kg(-1) min(-1)；1型糖尿病患者，0.58±0.12 mg kg（-1) min(-1)）。与第三组非糖尿病肾移植受者的比较表明，对葡萄糖反调节的有益影响是胰腺移植的结果，而不是相关的免疫抑制治疗的结果。我们的结论是，胰腺移植可以恢复低血糖诱导的胰高血糖素分泌和HGP，从而使低血糖后的血糖恢复正常化。
Although successful pancreas transplantation in humans with type I diabetes mellitus restores glucose-induced insulin secretion, provides freedom from insulin treatment, and normalizes fasting glucose levels, much less is known about its effects on counterregulation of hypoglycemia. To determine whether pancreas transplantation normalizes glucagon secretion and hepatic glucose production (HGP) during hypoglycemia, we performed hyperinsulinemic hypoglycemic clamps in successful recipients of pancreas allografts. Recipients were found to have glucagon secretory responses during hypoglycemia that were similar to those of control subjects (incremental glucagon response: recipients, 147 +/- 34 ng/L; control subjects, 161 +/- 43 ng/L, NS) but were significantly higher than those of matched subjects with type I diabetes (23 +/- 9 ng/L, P < 0.01). HGP rates at the end of 120 min of hypoglycemia were also significantly higher in recipients and control subjects than in subjects with diabetes (pancreas recipients, 1.92 +/- 0.33 mg kg(-1) min(-1); control subjects, 2.05 +/- 0.18 mg kg(-1) min(-1); subjects with type I diabetes, 0.58 +/- 0.12 mg kg(-1) min(-1)). A comparison with a third group of nondiabetic Kidney transplant recipients demonstrated that the beneficial effects on glucose counterregulation were a result of pancreas transplantation and not the associated immunosuppressive therapy. We conclude that pancreas transplantation restores hypoglycemia-induced glucagon secretion and HGP, thereby allowing for normalization of glucose recovery from hypoglycemia.