Reactive hypoglycaemia due to late dumping syndrome: successful treatment with acarbose.
Reactive hypoglycaemia due to late dumping syndrome: successful treatment with acarbose.
复制标题
晚期倾倒综合征引起的反应性低血糖：阿卡波糖的成功治疗。
作者：
A. Imhof;M. Schneemann;A. Schaffner;M. Brändle
反应性低血糖是一种罕见的疾病，在日常生活中发生在餐后，血糖水平低于2.5至2.8 mmol/l。我们报告一位66岁的病人，在食道切除颈部吻合术后10年，因晚期倾倒综合征而出现症状性反应性低血糖。75 g蔗糖负荷显示1小时后血糖水平为9.4 mmol/l，随后出现症状性低血糖，3小时后血糖水平为1.8 mmol/l。同时，测量了高浓度胰岛素（葡萄糖水平为9.4 mmol/l时为3216 pmol/l，葡萄糖水平为1.8 mmol/l时为335 pmol/l）和胰高血糖素样肽1（GLP-1）（葡萄糖水平为9.4 mmol/l时为375 pmol/l，葡萄糖水平为1.8 mmol/l时为85 pmol/l）。当患者接受阿卡波糖治疗时，另一次蔗糖负荷未引起症状性低血糖（2小时后血糖最低值为4.6 mmol/l）。当血糖为6.8 mmol/l时，胰岛素和GLP-1水平增加较少，1小时后分别达到375 pmol/l和75 pmol/l的峰值水平。我们的结论是，在胃肠道手术引起的反应性低血糖患者中，阿卡波糖降低了与高血糖和GLP-1分泌相关的快速葡萄糖吸收，从而减少了过度的胰岛素释放。因此，阿卡波糖是治疗晚期倾倒综合征引起的反应性低血糖的成功方法。
Reactive hypoglycaemia is a rare disease which occurs postprandially in everyday life involving blood glucose levels below 2.5 to 2.8 mmol/l. We report on a 66-year-old patient who developed symptomatic reactive hypoglycaemia due to late dumping syndrome 10 years after oesophagectomy with cervical anastomosis. A 75 g sucrose load revealed a plasma glucose level of 9.4 mmol/l after one hour, followed by symptomatic hypoglycaemia with a plasma glucose level of 1.8 mmol/l after three hours. Concomitantly, high concentrations of insulin (3216 pmol/l at a glucose level of 9.4 mmol/l and 335 pmol/l at a glucose level of 1.8 mmol/l) and glucagon-like peptide 1 (GLP-1) (375 pmol/l at a glucose level of 9.4 mmol/l and 85 pmol/l at a glucose level of 1.8 mmol/l) were measured. While the patient was under treatment with acarbose, another sucrose load did not provoke symptomatic hypoglycaemia (plasma glucose nadir of 4.6 mmol/l after two hours). Insulin and GLP-1 levels increased much less, to peak levels of 375 pmol/l and 75 pmol/l respectively, after one hour when plasma glucose was 6.8 mmol/l. We conclude that in patients with reactive hypoglycaemia due to gastrointestinal surgery, acarbose decreases rapid glucose absorption associated with hyperglycaemia and GLP-1 secretion, and thus diminishes excessive insulin release. Acarbose is therefore a successful treatment modality for reactive hypoglycaemia due to late dumping syndrome.