Smith D, Amiel S A
Guy's, King's and St Thomas' School of Medicine, London, UK.
Diabetologia. 2002 Jul;45(7):949-58. doi: 10.1007/s00125-002-0877-7. Epub 2002 Jun 8.
The intention of this paper is to critically review the current state of knowledge of the role of the brain in the syndrome of hypoglycaemia unawareness. Both the role of the brain in the detection of hypoglycaemia and initiation of the counterregulatory responses and the function of the cerebral cortex during acute hypoglycaemia are considered. The evidence for and against the brain as the primary site of mammalian hypoglycaemia sensing and the mechanisms whereby such sensing may occur and change in hypoglycaemia unawareness are discussed. Current evidence supports a major role for the central nervous system in hypoglycaemia sensing and there is increasing understanding of the mechanisms of counterregulatory failure and cognitive dysfunction in hypoglycaemia unawareness. More needs to be done to expand this understanding and translate it into therapeutic strategies to defend against severe hypoglycaemia in diabetes therapy.
本文旨在批判性地回顾目前关于大脑在低血糖无意识综合征中作用的知识现状。文中既考虑了大脑在低血糖检测及启动反调节反应中的作用，也探讨了急性低血糖期间大脑皮层的功能。讨论了支持和反对大脑作为哺乳动物低血糖感知主要部位的证据，以及这种感知可能发生的机制和在低血糖无意识状态下的变化。目前的证据支持中枢神经系统在低血糖感知中起主要作用，并且人们对低血糖无意识状态下反调节失败和认知功能障碍的机制有了越来越多的了解。为了扩展这种认识并将其转化为糖尿病治疗中预防严重低血糖的治疗策略，仍有更多工作要做。
