Changes in insulin sensitivity and clearance in anorexia nervosa.
Changes in insulin sensitivity and clearance in anorexia nervosa.
复制标题
神经性厌食症胰岛素敏感性和清除率的变化。
DOI：
10.1016/0026-0495(86)90021-1
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
B. Zinman
中科院分区：
文献类型：
--
作者：
S. Zúñiga;P. Garfinkel;B. Zinman
神经性厌食症（AN）是一种自我诱导的营养不良状态，其特征是追求苗条和害怕肥胖。虽然低空腹血糖和胰岛素已被证实，但在胰岛素敏感性方面存在矛盾的数据，并且缺乏关于胰岛素代谢及其在AN中的代谢作用的信息。采用正糖钳测量9例女性AN患者（年龄25.2±1.9岁，理想体重70.6±2.2%）的胰岛素敏感性、动力学和代谢效应，并与7例女性正常对照组（年龄23.6±1.0岁，理想体重92.7±2.5%）进行比较。空腹血糖（FPG）、免疫反应性胰岛素（IRI）、c肽含量（84.3±1.5 v 91.5±1.7 mg dL−1、9.3±1.0 v 13.5±1.4 μU mL−1、0.26±0.03 v 0.41±0.02 pmol mL−1）均显著低于NC （P< 0.05）。葡萄糖钳夹期间，AN组的葡萄糖代谢(M)、葡萄糖代谢清除率（MCR g）和单位胰岛素代谢葡萄糖（m1比）均高于NC组（M, 8.7±1.2 v 6.9±0.6 mg min−1 kg−1;MCR g, 9.9±1.5 v 7.4±0.6 mL min−1 kg−1；m1比，8.6±1.6 v 5.0±0.3 mg min−1 kg−1/μU mL−1× 100），但只有m1比有统计学意义（P< 0.05）。胰岛素代谢清除率（MCR I）由恒定胰岛素输注速率和血浆胰岛素浓度计算，AN组（13.4±1.5 mL min−1 kg−1）高于NC组（9.0±0.5 mL min−1 kg−1）（P< 0.02）。3-羟基丁酸、甘油和游离脂肪酸的空腹浓度在两组中相似，它们对稳态正糖高胰岛素血症的反应是相同的，两组中3-羟基丁酸和FFA水平下降了60%，甘油水平下降了40%。4例患者治疗成功后重新评估。FPG和IRI浓度向正常水平升高，而M、MCR g、m1比值和MCR I下降，与NC无明显差异。总之，这些结果表明，除了增加胰岛素敏感性外，神经性厌食症还与胰岛素代谢的显著变化有关，其特征是基础胰岛素水平下降和代谢清除率增加。这些变化可能是适应性的，以避免因热量限制而发生低血糖，并且在医院治疗方案的背景下，随着重新进食和体重增加，这些变化是可逆的。
Anorexia nervosa (AN) is a state of self-induced malnutrition characterized by a marked pursuit of thinness and the fear of obesity. Although low fasting blood glucose and insulin have been demonstrated, there is contradictory data on insulin sensitivity and a lack of information about insulin metabolism and its metabolic effects in AN. Insulin sensitivity, kinetics, and metabolic effects were measured using the euglycemic clamp in nine females with AN (age 25.2±1.9 years and 70.6±2.2% ideal body weight), and the results compared with seven female normal controls (NC)(age 23.6±1.0 years and 92.7±2.5% ideal body weight). Fasting plasma glucose (FPG), immunoreactive insulin (IRI), and C-peptide were significantly lower in AN as compared to NC (84.3±1.5 v 91.5±1.7 mg dL− 1, 9.3±1.0 v 13.5±1.4 μU mL− 1, and 0.26±0.03 v 0.41±0.02 pmol mL− 1)(P< 0.05). During the glucose clamp, the glucose metabolized (M), the metabolic clearance rate of glucose (MCR g), and the glucose metabolized per unit of insulin (M I ratio) were all higher in AN as compared to NC (M, 8.7±1.2 v 6.9±0.6 mg min− 1 kg− 1; MCR g, 9.9±1.5 v 7.4±0.6 mL min− 1 kg− 1; M I ratio, 8.6±1.6 v 5.0±0.3 mg min− 1 kg− 1/μU mL− 1× 100), but only the M I ratio attained statistical significance (P< 0.05). The metabolic clearance rate of insulin (MCR I) calculated from the constant insulin infusion rate and the plasma insulin concentrations was higher in AN (13.4±1.5 mL min− 1 kg− 1) as compared to NC (9.0±0.5 mL min− 1 kg− 1)(P< 0.02). Fasting concentration of 3-hydroxybutyrate, glycerol, and free fatty acids were similar in both groups, and their response to steady-state euglycemic hyperinsulinemia was the same with the levels of 3-hydroxybutyrate and FFA decreasing by 60% and of glycerol by 40% in both groups. Four patients were reassessed after successful treatment. FPG and IRI concentrations increased towards normal, while M, MCR g, M I ratio, and MCR I decreased and were now not different from NC. In summary, these results demonstrate that in addition to increased insulin sensitivity, anorexia nervosa is associated with marked changes in insulin metabolism characterized by decreased basal insulin levels and increased metabolic clearance. These changes may be adaptive in order to avoid hypoglycemia in response to caloric restriction and are reversible with refeeding and weight gain in the context of a hospital treatment program.
人类受试者胰岛素的内脏和肾脏代谢：剂量反应研究。
DOI：
10.1152/ajpendo.1983.244.6.e517
发表时间：
1983
期刊：
The American journal of physiology
影响因子：
--
作者：
Ferrannini,E;Wahren,J;Faber,OK;Felig,P;Binder,C;DeFronzo,RA
通讯作者：
DeFronzo,RA
人体胰岛素去除：受体介导过程的体内证据。
DOI：
10.1210/jcem-58-3-555
发表时间：
1984
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Eaton,RP;Friedman,N;Allen,RC;Schade,DS
通讯作者：
Schade,DS