Berlin I, Grimaldi A, Landault C, Zoghbi F, Thervet F, Puech A J, Legrand J C
Department of Clinical Pharmacology, Hôpital Pitié-Salpêtrière, Paris, France.
J Clin Endocrinol Metab. 1988 Feb;66(2):273-8. doi: 10.1210/jcem-66-2-273.
Plasma epinephrine, norepinephrine, and dopamine responses were studied in insulin-dependent diabetic patients at rest, on standing and during insulin-induced hypoglycemia. beta-Adrenergic sensitivity was evaluated by the isoproterenol sensitivity test. Five men who had adrenergic symptoms during hypoglycemia and no severe hypoglycemic accidents (coma, seizures) (group A) and five men who had repeated severe hypoglycemic accidents but lack of adrenergic symptoms of hypoglycemia (group B) were studied. The mean resting plasma epinephrine was lower in group B (147 +/- 22 pmol/L, SEM) than in group A (398 +/- 98 pmol/L, P less than 0.02). On standing plasma epinephrine increased significantly in both groups. During hypoglycemia blood glucose decreased identically in the two groups; plasma epinephrine and norepinephrine increased significantly and to the same extent in both groups; the mean maximal heart rate was significantly greater in group A than in group B. Isoproterenol sensitivity (defined as the dose of isoproterenol required to increase heart rate by 25 beats/min) was lower in group B (5.87 +/- 1.12 micrograms) than in group A (2.37 +/- 0.22 micrograms, P less than 0.01). The group B patients had significantly fewer hypoglycemic symptoms during insulin-induced hypoglycemia than did group A patients. We conclude that decreased beta-adrenergic sensitivity contributes to the lack of adrenergic symptoms of hypoglycemia in insulin-dependent diabetic patients.
研究了胰岛素依赖型糖尿病患者在静息、站立及胰岛素诱导的低血糖状态下血浆肾上腺素、去甲肾上腺素和多巴胺的反应。通过异丙肾上腺素敏感性试验评估β-肾上腺素能敏感性。研究了五名在低血糖期间有肾上腺素能症状且无严重低血糖事件（昏迷、癫痫发作）的男性（A组）和五名有反复严重低血糖事件但缺乏低血糖肾上腺素能症状的男性（B组）。B组静息血浆肾上腺素均值（147±22 pmol/L，标准误）低于A组（398±98 pmol/L，P<0.02）。站立时两组血浆肾上腺素均显著升高。低血糖期间两组血糖下降程度相同；两组血浆肾上腺素和去甲肾上腺素均显著升高且升高幅度相同；A组平均最大心率显著高于B组。B组异丙肾上腺素敏感性（定义为使心率增加25次/分钟所需的异丙肾上腺素剂量）（5.87±1.12微克）低于A组（2.37±0.22微克，P<0.01）。B组患者在胰岛素诱导的低血糖期间出现的低血糖症状明显少于A组患者。我们得出结论，β-肾上腺素能敏感性降低导致胰岛素依赖型糖尿病患者缺乏低血糖肾上腺素能症状。
