Letiexhe M R, Scheen A J, Lefèbvre P J
Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart Tilman, B-4000 Liège 1, Belgium.
Eat Weight Disord. 1997 Jun;2(2):79-86. doi: 10.1007/BF03339953.
From a metabolic point of view, anorexia nervosa may be viewed as a mirror image of obesity. We compared insulin secretion, clearance and action on glucose metabolism during an intravenous glucose tolerance test in nine women with anorexia nervosa and in nine age-matched normal-weight controls. Insulin secretion (ISR) was derived by deconvolution of plasma C-peptide levels, insulin clearance (MCR(I)) was obtained by dividing the area under the curve (AUC(0-180 min)) of ISR by the corresponding AUC of plasma insulin levels, insulin sensitivity (S(I)) and glucose effectiveness index (S(G)) were calculated by Bergman's minimal model. The anorectic women had markedly lower BMI values (13.7+/-0.6 vs 23.2+/-0.8 kg/m2, p<0.0001) and serum basal leptin levels (2.8+/-0.6 vs 8.9+/-1.8 ng/mL, p=0.005) than control women. The anorectic women exhibited clear-cut lower fasting and post-glucose plasma insulin levels but similar corresponding plasma C-peptide concentrations when compared to controls. Consequently, ISR was similar in both groups while MCR(I) was significantly increased in anorexia nervosa (MCR(I): 3320+/-881 vs 822+/-79 mL x min(-1) x m(-2), p<0.02). The index S(I) tended to be higher in anorectic women than in normal-weight subjects, but without reaching the level of statistical significance because of a high between-subject variability (20.2+/-5.7 vs 12.5+/-2.2 10(-5) x min(-1)/pmol x L(-1), NS). The index S(G) was similar in both groups (0.022+/-0.004 vs 0.018+/-0.002 min(-1), NS). In conclusion, low plasma insulin levels observed in women with anorexia nervosa result from high MCR(I) rather than from depressed insulin secretion. Insulin sensitivity is not systematically increased and glucose effectiveness is unchanged in anorectic women when compared to normal-weight controls.
从代谢角度来看，神经性厌食症可被视为肥胖症的镜像。我们比较了9名神经性厌食症女性和9名年龄匹配的正常体重对照者在静脉葡萄糖耐量试验期间的胰岛素分泌、清除率及对葡萄糖代谢的作用。胰岛素分泌率（ISR）通过血浆C肽水平的反卷积法得出，胰岛素清除率（MCR(I)）通过将ISR的曲线下面积（AUC(0 - 180分钟)）除以血浆胰岛素水平的相应AUC来获得，胰岛素敏感性（S(I)）和葡萄糖效能指数（S(G)）通过伯格曼最小模型计算得出。厌食症女性的BMI值（13.7±0.6 vs 23.2±0.8 kg/m²，p<0.0001）和血清基础瘦素水平（2.8±0.6 vs 8.9±1.8 ng/mL，p = 0.005）明显低于对照女性。与对照组相比，厌食症女性空腹及葡萄糖负荷后血浆胰岛素水平明显较低，但相应的血浆C肽浓度相似。因此，两组的ISR相似，而神经性厌食症患者的MCR(I)显著升高（MCR(I)：3320±881 vs 822±79 mL·min⁻¹·m⁻²，p<0.02）。厌食症女性的S(I)指数往往高于正常体重受试者，但由于个体间差异较大，未达到统计学显著水平（20.2±5.7 vs 12.5±2.2 10⁻⁵·min⁻¹/pmol·L⁻¹，无显著性差异）。两组的S(G)指数相似（0.022±0.004 vs 0.018±0.002 min⁻¹，无显著性差异）。总之，神经性厌食症女性中观察到的低血浆胰岛素水平是由高MCR(I)导致的，而非胰岛素分泌减少。与正常体重对照者相比，厌食症女性的胰岛素敏感性并非系统性升高，葡萄糖效能也未改变。
