Morricone L, Bombonato M, Cattaneo A G, Enrini R, Lugari R, Zandomenighi R, Caviezel F
Cattedra di Endocrinologia, Istituto di Scienze Medico-Chirurgiche S. Donato, Università di Milano, Italy.
Horm Metab Res. 2000 Jun;32(6):240-5. doi: 10.1055/s-2007-978628.
The data concerning the cephalic phase of insulin secretion (CPIS) in human obesity are controversial. We investigated the effect of a variety of sensory challenges on CPIS in 17 non-diabetic obese patients (four males, 13 females, mean age 41.1 years, mean BMI 38.7). Water, saccharin, and lemon juice were used as oral stimuli, and a complete meal was simply presented as visual and olfactory stimulations. Twelve healthy normal-weight subjects (four men, eight women, mean age 39.9, mean BMI 22.5) also underwent oral stimulation as controls, and the patients who underwent the sight and smell stimulations were also tested for pancreatic polypeptide (PP) changes in order to verify the occurrence of truly cephalic reflex during the test. Insulin levels were measured before and after each stimulation (every min for the first 5 min, and then after 10, 20, and 30 min). None of the stimuli (saccharin, lemon juice or water retained in the mouth for 2 min and were then spat out; the combined and separate sight and smell of a meal for 2 min) led to a significant increase in insulin in the obese patients (except in the case of one woman after oral stimulation). The oral stimuli led to a variable CPIS in one female and three male controls. Despite the absence of CPIS, the five obese patients undergoing all three sensory stimulations related to the meal (combined sight and smell, sight alone and smell alone) showed an early and significant increase in plasma PP concentrations within the first 3 min; this was more pronounced after the combined than after the separate exposure. Although only preliminary, these results underline the variability but substantial lack of CPIS in obese patients, thus suggesting that it can be considered a relatively rare and unrelevant event even in the presence of a true brain-mediated reflex revealed by the rapid and consistent increase in PP found in our experiments.
关于人类肥胖症中胰岛素分泌头期（CPIS）的数据存在争议。我们研究了多种感觉刺激对17名非糖尿病肥胖患者（4名男性，13名女性，平均年龄41.1岁，平均BMI 38.7）CPIS的影响。水、糖精和柠檬汁用作口腔刺激物，一顿完整的餐食仅作为视觉和嗅觉刺激呈现。12名健康的正常体重受试者（4名男性，8名女性，平均年龄39.9岁，平均BMI 22.5）也接受口腔刺激作为对照，接受视觉和嗅觉刺激的患者还检测了胰多肽（PP）的变化，以验证测试期间是否发生真正的头期反射。在每次刺激前后测量胰岛素水平（前5分钟每分钟测量一次，然后在10、20和30分钟后测量）。在肥胖患者中，没有一种刺激（糖精、柠檬汁或水在口中保留2分钟后吐出；一顿餐食的视觉和嗅觉组合及单独刺激各2分钟）导致胰岛素显著增加（一名女性在口腔刺激后除外）。口腔刺激在一名女性和三名男性对照中导致了可变的CPIS。尽管缺乏CPIS，但接受与餐食相关的所有三种感觉刺激（视觉和嗅觉组合、单独视觉和单独嗅觉）的五名肥胖患者在最初3分钟内血浆PP浓度出现早期且显著升高；联合刺激后比单独刺激后更明显。尽管只是初步结果，但这些结果强调了肥胖患者中CPIS的变异性但大量缺乏，因此表明即使在我们实验中发现的PP快速且持续增加所揭示的真正脑介导反射存在的情况下，也可认为CPIS是相对罕见且不相关的事件。
