Piccardo M G, Pacini G, Rosa M, Vichi R
2nd Medical Clinic, University La Sapienza of Rome, Italy.
Enzyme. 1991;45(1-2):14-22. doi: 10.1159/000468860.
The aim of the present study was to obtain a comprehensive picture of the rate of insulin secretion and of tissue sensitivity to the endogenous hormone in myotonic dystrophy patients (MyD). The minimal model approach was utilized for the analysis of frequently sampled intravenous glucose tolerance test data (FSIGT). This method provided the characteristic parameters: SI, insulin sensitivity index; SG fractional glucose disappearance independent of dynamic insulin; n, fractional insulin clearance; phi 1 and phi 2 first and second phase insulin delivery sensitivities to glucose stimulation. In MyD patients SI was reduced (p less than 0.01) by 71% to 1.4 +/- 0.3 x 10(-4) min-1/(microU/ml), whereas in controls it was 4.85 +/- 0.77; SG was within the normal range: 0.044 +/- 0.012 min-1 in MyD patients and 0.036 +/- 0.017 min-1 in controls; phi 1 increased in MyD patients (7.4 +/- 1.3 min (microU/ml)/(mg/dl) versus 4.1 +/- 1.2 in controls); phi 2 increased in MyD patients (126 +/- 47 x 10(4) min-2/(microU/ml)/(mg/dl) versus 17 +/- 6 in controls; p less than 0.05). MyD patients showed a normal tolerance with the glucose disappearance constant, KG within the normal range: 2.75 versus 2.62% min-1 in controls. In MyD patients insulin resistance was associated with a higher than normal insulin delivery for both secretory phases, although the second phase was responsible for releasing a greater amount of hormone. In conclusion MyD patients try to compensate for overall insulin resistance by a more marked pancreatic response.
本研究的目的是全面了解强直性肌营养不良症患者（MyD）的胰岛素分泌速率以及组织对内源性激素的敏感性。采用最小模型法分析频繁采样的静脉葡萄糖耐量试验数据（FSIGT）。该方法提供了特征参数：SI，胰岛素敏感性指数；SG，独立于动态胰岛素的葡萄糖分数消失率；n，胰岛素分数清除率；phi 1和phi 2，胰岛素释放对葡萄糖刺激的第一和第二阶段敏感性。在MyD患者中，SI降低（p<0.01）71%，降至1.4±0.3×10⁻⁴ min⁻¹/(μU/ml)，而对照组为4.85±0.77；SG在正常范围内：MyD患者为0.044±0.012 min⁻¹，对照组为0.036±0.017 min⁻¹；phi 1在MyD患者中增加（7.4±1.3 min (μU/ml)/(mg/dl)，而对照组为4.1±1.2）；phi 2在MyD患者中增加（126±47×10⁴ min⁻²/(μU/ml)/(mg/dl)，而对照组为17±6；p<0.05）。MyD患者的葡萄糖消失常数KG在正常范围内，显示出正常的耐受性：对照组为2.75对2.62% min⁻¹。在MyD患者中，胰岛素抵抗与两个分泌阶段高于正常的胰岛素释放相关，尽管第二阶段释放的激素量更大。总之，MyD患者试图通过更明显的胰腺反应来补偿整体胰岛素抵抗。
