Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome
Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome
复制标题
DOI：
10.1023/a:1010635131228
复制
发表时间：
2001-09-01
影响因子：
3.1
通讯作者：
Miholic, J
中科院分区：
文献类型：
--
作者：
Gebhard, B;Holst, JJ;Miholic, J
胃切除术患者口服葡萄糖后反应性低血糖发生前胃快速排空和促胰岛素分泌激素GLP-1血浆浓度升高。我们怀疑与快速胃排空（早期倾倒）相关的血浆容量下降将伴随去甲肾上腺素血浆浓度升高。为了研究餐后去甲肾上腺素、肠胰岛轴和血糖之间的关系，对12例倾倒综合征患者和9例对照者进行了研究。在1.5 g/kg瘦体重葡萄糖餐后测量去甲肾上腺素、GLP-1、GIP、胰高血糖素、胰岛素和葡萄糖的血浆浓度。早期（0-30分钟）的去甲肾上腺素浓度在垃圾者中（22.1 ± 3.8 nmol/ml/min）显著高于对照者（14.7 ± 3.1 nmol/ml/min; P < 0.001），并且与餐后红细胞压积增加密切相关（r = 0.71; P < 0.05）。GLP-1，GIP和胰高血糖素的早期免疫反应在葡萄糖摄入后30分钟达到峰值，并且在倾倒者中显着较高。胰岛素在60分钟后达到峰值，并与早期GLP-1相关。在11名患者中，血糖在中位间隔120分钟后降至基线以下。在大多数最低点发生的120分钟时，早期GLP-1浓度高的患者血糖最低（r = 0.78; P < 0.001）。凝胶过滤色谱自卸车的血浆显示，胰高血糖素是可检测的时间0和20分钟后，但不是120分钟后。它的结论是，在自卸车胰高血糖素增加在餐后早期，可能通过刺激的儿茶酚胺。在120分钟时，当遇到大多数低血糖时，胰高血糖素不再可检测到，可能是通过GLP-1的抑制。
Rapid gastric emptying and exaggerated plasma concentrations of the insulinotropic hormone GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients. We suspected that the plasma volume drop associated with rapid gastric emptying (early dumping) would be accompanied by elevated plasma concentrations of norepinephrine. In order to study any relationship between postprandial norepinephrine, the enteroinsular axis, and plasma glucose, twelve patients with dumping syndrome and nine controls were studied. The plasma concentrations of norepinephrine, GLP-1, GIP, glucagon, insulin, and glucose were measured following a 1.5 g/kg lean body mass glucose meal. The early (0-30 min) integrated norepinephrine concentration was significantly higher in dumpers (22.1 +/- 3.8 nmol/ml/min) compared to controls (14.7 +/- 3.1 nmol/ml/min; P < 0.001) and correlated closely with the postprandial hematocrit increment (r = 0.71; P < 0.05). Early immunoreactivities of GLP-1, GIP, and glucagon peaked 30 min after glucose ingestion and were significantly higher in dumpers. Insulin peaked after 60 min and correlated with early GLP-1. In 11 of the patients glucose fell below baseline after a median interval of 120 min. Glucose at 120 min, when most of the nadirs occurred was lowest in patients with high early GLP-1 concentrations (r = 0.78; P < 0.001). Gel filtration chromatography of the dumpers' plasma revealed that pancreatic glucagon was detectable at time 0 and after 20 min, but not after 120 min. It is concluded that in dumpers pancreatic glucagon is augmented in the early postprandial period, probably through stimulation by catecholamines. At 120 min, when most of the hypoglycemias are encountered, pancreatic glucagon is no longer detectable, probably through inhibition by GLP-1.