Cresto J C, Sires J M, Ramos O, Abdenur J E, Basabe J C
Unidad de Endocrinología, Hospital General de Niños Dr. Pedro de Elizalde, Buenos Aires.
Medicina (B Aires). 1991;51(3):195-203.
We define diabetic remission as the disappearance of clinical symptoms with normalization of blood glucose for a period over 15 days after withdrawal of insulin therapy. We studied 21 insulin-dependent diabetic children in remission (10 boys and 11 girls) and 29 normal children matched in age and sex as controls. Two tests were performed, intravenous glucose (IVGT) and glucose post-tolbutamide (PTGT). Two remission groups were studied with IVGT. Glucose, insulin, somatotropin and glucagon were determined in one and glucose and C-peptide in the other. Insulin secretion after IVGT was very low in the remission group, not surpassing basal value when stimulated. Only two girls showed normal or high insulin values during the study, and one of them showed the common hypoinsulinism of the remission group in a second study. The kinetics of glucagon and somatotropin secretion in the remission group were normal with low values of glucagon. When the integrated area (0-120 min) of hormone secretion (insulin, somatotropin and glucagon) was determined, the remission group had lower insulin and glucagon values (p less than 0.05) and identical growth hormone as the normal group. The insulin/glucagon ratio in normals and in remission were similar. During IVGT the remission group studied for C-peptide showed lower C-peptide values than normal group, resembling insulin behavior. In both groups, the glucose disappearance rate ("K" value) was higher in normals than in remissions (p less than 0.001). During the PTGT the normal group showed a peak of insulin secretion after tolbutamide and glucose stimulation. In the remission group, glucose was higher and insulin secretion lower than in the normal group, without a peak of insulin, and growth hormone and glucagon secretion were also lower.(ABSTRACT TRUNCATED AT 250 WORDS)
我们将糖尿病缓解定义为在停用胰岛素治疗后15天以上，临床症状消失且血糖恢复正常。我们研究了21例处于缓解期的胰岛素依赖型糖尿病儿童（10名男孩和11名女孩）以及29名年龄和性别匹配的正常儿童作为对照。进行了两项测试，静脉葡萄糖耐量试验（IVGT）和甲苯磺丁脲后葡萄糖耐量试验（PTGT）。对IVGT研究了两个缓解组。一组测定葡萄糖、胰岛素、生长激素和胰高血糖素，另一组测定葡萄糖和C肽。缓解组IVGT后的胰岛素分泌非常低，刺激时未超过基础值。在研究期间，只有两名女孩的胰岛素值正常或偏高，其中一名女孩在第二项研究中表现出缓解组常见的低胰岛素血症。缓解组中胰高血糖素和生长激素的分泌动力学正常，胰高血糖素值较低。当测定激素分泌（胰岛素、生长激素和胰高血糖素）的积分面积（0 - 120分钟）时，缓解组的胰岛素和胰高血糖素值较低（p < 0.05），生长激素与正常组相同。正常组和缓解组的胰岛素/胰高血糖素比值相似。在IVGT期间，研究C肽的缓解组C肽值低于正常组，类似于胰岛素的表现。在两组中，正常组的葡萄糖消失率（“K”值）高于缓解组（p < 0.001）。在PTGT期间，正常组在甲苯磺丁脲和葡萄糖刺激后出现胰岛素分泌高峰。在缓解组中，葡萄糖水平高于正常组，胰岛素分泌低于正常组，没有胰岛素高峰，生长激素和胰高血糖素分泌也较低。（摘要截断于250字）
