Importance of raised growth hormone levels in mediating the metabolic derangements of diabetes.
Importance of raised growth hormone levels in mediating the metabolic derangements of diabetes.
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生长激素水平升高在调节糖尿病代谢紊乱中的重要性。
DOI：
10.1056/nejm198403293101302
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
Sherwin,RS
中科院分区：
文献类型：
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作者：
Press,M;Tamborlane,WV;Sherwin,RS
为了评估生长激素水平升高（糖尿病控制不佳的特征）的重要性，我们向接受胰岛素泵治疗的 14 名糖尿病患者以每小时 100 μg 脉冲的形式给予生长激素 21 至 45 小时。胰岛素泵设置和膳食保持不变。平均 24 小时生长激素水平 (±S.E.M.) 从 8±1 纳克每毫升上升至 16±2 纳克每毫升，该值与在其他 12 名糖尿病控制不佳的患者中观察到的值相同（17±3 纳克每毫升）。血浆葡萄糖浓度在8至10小时内翻倍，并保持升高直至停止生长激素（空腹血糖水平在18小时时从86±11毫克每分升升至204±17毫克每分升，在42小时时升至240±20毫克每分升）。高血糖主要是由于肝脏葡萄糖产生的显着刺激，而游离胰岛素或胰高血糖素水平没有变化。循环游离脂肪酸、酮和支链氨基酸的水平也有所增加。尽管优化了胰岛素治疗，但控制不佳的糖尿病中发生的生长激素水平的适度升高本身可以重现与糖尿病控制不佳相关的整个异常代谢燃料浓度。因此，生长激素分泌过多可能是糖尿病控制不良的原因和结果。 （新英格兰医学杂志 1984 年；310：810–5。）
To evaluate the importance of the raised levels of growth hormone that characterize poor diabetic control, we gave growth hormone for 21 to 45 hours in the form of hourly 100-μg pulses to 14 diabetics being treated by insulin pump. Insulin-pump settings and meals were kept constant. Mean 24-hour levels of growth hormone (±S.E.M.) rose from 8± 1 to 16±2 ng per milliliter — values identical to those observed in 12 other patients with poorly controlled diabetes (17±3 ng per milliliter). Plasma glucose concentrations doubled within 8 to 10 hours and remained elevated until growth hormone was discontinued (fasting glucose level rose from 86±11 to 204±17mg per deciliter at 18 hours and to 240±20 mg per deciliter at 42 hours). The hyperglycemia was due mainly to a marked stimulation of hepatic glucose production that occurred without changes in levels of free insulin or glucagon. Levels of circulating free fatty acids, ketones, and branched-chain amino acids were also increased.The moderate elevations in growth hormone levels that occur in poorly controlled diabetes can themselves reproduce the whole spectrum of abnormal metabolic fuel concentrations that are associated with poor diabetic control, despite optimized insulin treatment. Thus, hypersecretion of growth hormone may be the cause as much as the consequence of poor diabetic control. (N Engl J Med 1984; 310:810–5.)