INSULIN-DEPRIVED DIABETIC PANCREATIC VENOUS DIVERSION

该提案是关于两个国家之间的一个合作研究项目 南加州大学(USC)和肝病研究所 代谢外科(DLMS)，莫斯科谢切诺夫医学院 俄罗斯。洛杉矶的R.N.Bergman和T.Buchanan长期以来 对糖尿病的发病机制和病因感兴趣。在……里面 特别是，他得到了美国国立卫生研究院(DK29867)的资助，以研究 控制肝脏葡萄糖输出的因素。很明显， 糖尿病的特征是高血糖，它是由高血糖发生率引起的 空腹状态下肝脏葡萄糖输出量(HGO)的减少 摄入碳水化合物后胰岛素抑制HGO的能力。显然 缺乏胰岛素是人体葡萄糖生产过剩的一个重要因素 1型(“青少年发病”)糖尿病患者。不太清楚的是， 糖原分解、糖异生的门静脉水平升高的重要性 荷尔蒙高血糖素。胰高血糖素在糖尿病高血糖中的作用 以及压力和锻炼条件对许多人来说都是有争议的 好几年了。混乱是由于无法明确地压制 1型患者的胰高血糖素分泌。然而，外科手术 加尔佩林博士在莫斯科开创的这项技术应该能让我们研究 高血糖在糖尿病病因学中的意义。他有 400余例糖尿病患者行脾肾静脉吻合术 前苏联的患者(大多数在俄罗斯)。因此，因为 胰腺静脉流出进入全身而不是门静脉 循环中，可以预期进入体内的胰升糖素水平 手术患者的肝脏应明显低于非手术患者。 手术治疗的糖尿病患者。我们建议利用 这一大群接受手术的糖尿病患者是否可以 评估高血糖素血症在1型糖尿病病因学中的重要性 糖尿病患者。加尔佩林博士和他的同事们将进行临床试验。 莫斯科对两组糖尿病患者的治疗方案：那些有 以及那些没有接受过脾肾分流术的患者。我们将测试 假设i)进入肝脏的胰高血糖素水平较低 手术受试者；2)空腹血糖产生率 手术患者，与相对低血糖素血症有关；3) 由于较低的胰升糖素，手术患者的肝脏对 胰岛素是由于胰高血糖素降低所致。协议将在莫斯科执行，以及 血浆样本将被运往洛杉矶进行化学和统计 分析。

The proposal is for a collaborative research project between the University of Southern California (USC) and the Department of Liver and Metabolic Surgery (DLMS), at the Moscow Sechenov Medical Academy in Russia. R. N. Bergman and T. Buchanan in Los Angeles has long been interested in the pathogenesis and etiology of diabetes mellitus. In particular, he is funded by the NIH (DK29867 -"parent grant") to study the factors which control glucose output by liver. It is clear that the hyperglycemia which characterizes diabetes results from an elevated rate of hepatic glucose output (HGO) in the fasting state, and a reduced ability of insulin to suppress HGO after carbohydrate ingestion. Clearly lack of insulin is an important factor in the overproduction of glucose in the Type 1 ("juvenile-onset") diabetic. Less clear is the possible importance of elevated portal levels of the glycogenolytic, gluconeogenic hormone glucagon. The role of glucagon in hyperglycemia of diabetes, as well as in stress and exercise conditions has been controversial for many years. Confusion has resulted from the inability to specifically suppress glucagon secretion in Type 1 patients. However, a surgical operation pioneered in Moscow by Dr. Galperin should allow us to examine the significance of hyperglucagonemia in the etiology of diabetes. He has performed the spleno-renal venous anastomoses in over 400 diabetic patients in the former Soviet Union (most in Russia). Thus, because the pancreatic venous outflow enters the systemic rather than the portal circulation, it is to be expected that the levels of glucagon entering the liver in the operated patients should be considerably lower than in non- operated diabetic patients. We propose to take advantage of the availability of this large population of operated diabetic patients to evaluate the importance of hyperglucagonemia in the etiology of Type 1 diabetics. Dr. Galperin and his colleagues will perform clinical. protocols in Moscow on 2 groups of diabetic patients: those who have had, and those who have not had the spleno-renal shunt procedure. We will test the hypotheses that I) glucagon levels entering the liver are lower in operated subjects; 2) fasting glucose production rates are lower in operated patients and this is related to the relative hypoglucagonemia; 3) due to lower glucagon, livers of operated patients are more sensitive to insulin due to lower glucagon. Protocols will be performed in Moscow, and plasma samples will be shipped to Los Angeles for chemical and statistical analysis.