SEQUENCE OF EVENTS DURING DEVELOPMENT OF THE DAWN PHENOMENON IN INSULIN-DEPENDENT DIABETES-MELLITUS
SEQUENCE OF EVENTS DURING DEVELOPMENT OF THE DAWN PHENOMENON IN INSULIN-DEPENDENT DIABETES-MELLITUS
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DOI：
10.1016/0026-0495(85)90153-2
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发表时间：
1985-01-01
影响因子：
9.8
通讯作者：
GERICH, JE
中科院分区：
文献类型：
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作者：
CAMPBELL, PJ;BOLLI, GB;GERICH, JE
在 10 名先前血糖正常的 IDDM 患者 (Biostator) 中，从下午 12 点至上午 8 点持续输注胰岛素 (0.15 mU .cntdot. kg-1 .cntdot. min-1) 期间，血浆葡萄糖 (5.4 .+-. 下午 12 点 0.2 mmol/L) 于凌晨 3:30 增加并达到 12.1 .+-。上午 8 点为 1.6 mmol/L (P < 0.001)。凌晨 3:30 葡萄糖产量也有所增加；尽管存在高血糖，但直到凌晨 5 点之后葡萄糖利用率才增加。血浆生长激素（中午 12 点至凌晨 4 点）、皮质醇（凌晨 3:30 后）、去甲肾上腺素（凌晨 1:30 后）和肾上腺素（凌晨 3:30 后）在一夜之间显着增加，但胰高血糖素未显着增加，但血浆肾上腺素和去甲肾上腺素仍处于阈下水平。胰岛素清除率增加（约 25%，P < 0.05），但仅在上午 7 点后出现，导致血浆胰岛素减少 4 mU/L。血浆葡萄糖的增加和葡萄糖产量的增加之间存在显着相关性（r = 0.74，P < 0.05），而葡萄糖产量的增加又与血浆生长激素的夜间峰值显着相关（r = 0.66，P < 0.05）。根据观察到的事件顺序，我们得出结论，IDDM 中的黎明现象比目前认为的更早开始（约凌晨 3:30），这是由于葡萄糖产生加速和葡萄糖利用受损造成的，并且交感神经系统活动和/或生长激素分泌的夜间增加，但皮质醇、肾上腺素和胰高血糖素分泌的变化或胰岛素清除率的变化，可能具有重要的发病机制。
During constant insulin infusion (0.15 mU .cntdot. kg-1 .cntdot. min-1) from 12 PM to 8 AM in 10 IDDM patients previusly rendered euglycemic (Biostator), plasma glucose (5.4 .+-. 0.2 mmol/L at 12 PM) increased by 3:30 AM and reached 12.1 .+-. 1.6 mmol/L at 8 AM (P < 0.001). Glucose production also increased at 3:30 AM; despite hyperglycemia, glucose utilization did not increase until after 5 AM. Plasma growth hormone (12 PM to 4 AM), cortisol (after 3:30 AM), noradrenaline (after 1:30 AM), and adrenaline (after 3:30 AM) but not glucagon increased significantly overnight, although plasma adrenaline and noradrenaline remained at subthreshold levels. Insulin clearance increased (.apprx. 25%, P < 0.05) but only after 7 AM, resulting in a 4 mU/L decrease in plasma insulin. A significant correlation was found between increases in plasma glucose and increases in glucose production (r = 0.74, P < 0.05) which in turn were significantly correlated with nocturnal peaks in plasma growth hormone (r = 0.66, P < 0.05). From the sequence of events observed, we conclude that the Dawn Phenomenon in IDDM begins earlier than is currently thought (.apprx. 3:30 AM), that it is due to both accelerated glucose production and impaired glucose utilization, and that nocturnal increases in sympathetic nervous system activity and/or growth hormone secretion, but not changes in secretion of cortisol, adrenaline and glucagon or changes in insulin clearance, may be of pathogenetic importance.