Kondo Y, Suzuki S, Gomi Y, Mayumi K, Sakamaki T, Inoue T, Iino S
Department of Internal Medicine, Showa University Fujigaoka Hospital.
Nihon Naibunpi Gakkai Zasshi. 1992 Dec 20;68(12):1257-68. doi: 10.1507/endocrine1927.68.12_1257.
To investigate the mechanism of glucose intolerance in patients with Graves' disease, a 2-hour oral glucose tolerance test and euglycemic glucose clamp study using Biostator were performed in patients with Graves' disease and control subjects. 80 per cent of the patients showed impaired glucose tolerance. Insulinogenic index in the patients with borderline or diabetic glucose response was lower than that in subjects with normal glucose response. Insulinogenic index was inversely correlated with sigma PG during the test. Despite normal basal plasma glucose concentrations, basal plasma insulin levels in the patients with Graves' disease were higher than in the controls. Using the euglycemic glucose clamp technique, the glucose utilization rate (M value), the metabolic clearance rate of glucose (MCRG) and the insulin sensitivity index (M/I x 100) in the patients with Graves' disease were lower than in the controls. After treatment with antithyroid drug in 3 patients, glucose tolerance completely normalized, and there was a significant increase in the M value and the MCRG and a significant decrease in the metabolic clearance rate of insulin (MCRI) compared to the values before treatment. In the patients with Graves' disease, basal serum glucagon levels were higher than in the controls, and glucagon suppression during insulin infusion was found to be decreased. From these data, it is concluded that the decrease in glucose tolerance in patients with Graves' disease can be explained by 1) the impairment of early insulin release response to rapid intestinal glucose absorption, 2) increased insulin metabolic clearance and 3) hyperglucagonemia.
为研究格雷夫斯病患者糖耐量异常的机制，对格雷夫斯病患者和对照者进行了2小时口服葡萄糖耐量试验以及使用Biostator的正常血糖葡萄糖钳夹研究。80%的患者显示糖耐量受损。血糖反应处于临界值或糖尿病水平的患者的胰岛素生成指数低于血糖反应正常的受试者。试验期间胰岛素生成指数与餐后血糖标准差呈负相关。尽管基础血浆葡萄糖浓度正常，但格雷夫斯病患者的基础血浆胰岛素水平高于对照组。使用正常血糖葡萄糖钳夹技术，格雷夫斯病患者的葡萄糖利用率（M值）、葡萄糖代谢清除率（MCRG）和胰岛素敏感性指数（M/I×100）低于对照组。3例患者使用抗甲状腺药物治疗后，糖耐量完全恢复正常，与治疗前相比，M值和MCRG显著增加，胰岛素代谢清除率（MCRI）显著降低。在格雷夫斯病患者中，基础血清胰高血糖素水平高于对照组，且发现胰岛素输注期间胰高血糖素抑制作用降低。从这些数据得出结论，格雷夫斯病患者糖耐量降低可由以下原因解释：1）对快速肠道葡萄糖吸收的早期胰岛素释放反应受损；2）胰岛素代谢清除增加；3）高胰高血糖素血症。
